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Sample records for cardiopulmonary resuscitation training

  1. Cardiopulmonary resuscitation.

    Science.gov (United States)

    Rieser, T M

    2000-05-01

    Cardiopulmonary resuscitation (CPR) is a technique used in both human and veterinary medicine. Although a number of innovative adaptations to CPR have been researched, the mainstay of CPR remains intubation, adequate ventilation, chest compressions, and basic drug therapy. The purpose of this article is to review the techniques and drugs commonly used in both closed chest and open chest CPR.

  2. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B

    2008-01-01

    individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines......BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during...... for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify...

  3. [Need of cardiopulmonary resuscitation training in the sport of soccer].

    Science.gov (United States)

    Guerra-Martín, María Dolores; Martínez-Montilla, José Manuel; Amador-Marín, Bárbara

    2016-01-01

    In Spain there are around 25,000 cardiac arrests, many of them in the presence of non-medical personnel. In less than 25% of the cardio-respiratory arrests witnessed, witnesses began cardiopulmonary resuscitation. Soccer is a contact sport with multiple physical characteristics and requirements which pushes your body to the limit, thus leading to a higher chance of developing multiple lesions, including cardio-respiratory arrest. Therefore, our goal was to know the actual situation on training in basic life support in soccer. A literature review was performed on different databases both national (IME, CUIDEN, ENCUENTR@, ENFERMERÍA AL DÍA, ISOC) and international (PUBMED, SCOPUS, CINAHL), with different MESH descriptors related to the topic. A total of 395 references were identified. 17 studies were selected; 8 of them had like main theme cardiopulmonary resuscitation and the remaining 9 spoke on the use of semi-automatic defibrillators. There is a lack of research on this topic in soccer. This strikes our attention because in this area there could be situations requiring immediate rescue action. Therefore, we emphasize the importance of early cardio-respiratory resuscitation because training in basic life support and semi-automatic defibrillators in soccer are fundamental. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  4. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital

    Science.gov (United States)

    Garg, Rakesh; Ahmed, Syed Moied; Kapoor, Mukul Chandra; Mishra, Bibhuti Bhusan; Rao, SSC Chakra; Kalandoor, M Venkatagiri; Divatia, Jigeeshu Vasishtha; Singh, Baljit

    2017-01-01

    The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS) for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation. PMID:29217852

  5. Basic cardiopulmonary life support (BCLS for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2017-01-01

    Full Text Available The cardiopulmonary resuscitation guideline of Basic Cardiopulmonary Life Support (BCLS for management of adult victims with cardiopulmonary arrest outside the hospital provides an algorithmic stepwise approach for optimal outcome of the victims by trained medics and paramedics. This guideline has been developed considering the need to have a universally acceptable practice guideline for India and keeping in mind the infrastructural limitations of some areas of the country. This guideline is based on evidence elicited in the international and national literature. In the absence of data from Indian population, the excerpts have been taken from international data, discussed with Indian experts and thereafter modified to make them practically applicable across India. The optimal outcome for a victim with cardiopulmonary arrest would depend on core links of early recognition and activation; early high-quality cardiopulmonary resuscitation, early defibrillation and early transfer to medical facility. These links are elaborated in a stepwise manner in the BCLS algorithm. The BCLS also emphasise on quality check for various steps of resuscitation.

  6. Cardiopulmonary resuscitation training in Washington state public high schools.

    Science.gov (United States)

    Reder, Sheri; Quan, Linda

    2003-03-01

    To determine the best approaches for increasing cardiopulmonary resuscitation (CPR) training opportunities for public high school students, we conducted a statewide survey of all 310 public high schools in Washington State. The findings describe CPR student training currently provided by high schools, barriers to providing, and strategies to increase CPR training of high school students. The response rate was 89% (276 schools) from a combination of mail and telephone surveys; 35% (n=97) reported that they did not provide any CPR student training. Of the 132 schools that provided CPR student training, 23% trained less than 10% of their students, and 39% trained more than 90% of their students. The majority of public high schools, 70%, did not have any teacher trained to teach CPR or had only one teacher with such training. Yet 80% of schools felt that CPR training is best provided in school settings. Schools perceived the greatest benefit of CPR training as providing students with the skill to save a life (43%). The most frequently identified barriers were logistical: limited time to teach the curriculum (24%), lack of funds (16%), and instructor scheduling difficulties (17%). Less than 5% of respondents voiced any opposition to CPR training, and that opposition was for logistical reasons. To increase CPR training, the single best strategies suggested were: increase funding, provide time in the curriculum, have more certified instructors, and make CPR student training a requirement.

  7. Cardiopulmonary Resuscitation Training Disparities in the United States.

    Science.gov (United States)

    Blewer, Audrey L; Ibrahim, Said A; Leary, Marion; Dutwin, David; McNally, Bryan; Anderson, Monique L; Morrison, Laurie J; Aufderheide, Tom P; Daya, Mohamud; Idris, Ahamed H; Callaway, Clifton W; Kudenchuk, Peter J; Vilke, Gary M; Abella, Benjamin S

    2017-05-17

    Bystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual-level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training. We administered a cross-sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97-0.99; P trained: OR, 0.99; 95% CI, 0.98-0.99; P =0.04). Furthermore, there was a greater then 4-fold difference in odds of being currently CPR trained from the 30-39 to 70-79 year old age groups (95% CI, 0.10-0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income ( P training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  8. A paediatric cardiopulmonary resuscitation training project in Honduras.

    Science.gov (United States)

    Urbano, Javier; Matamoros, Martha M; López-Herce, Jesús; Carrillo, Angel P; Ordóñez, Flora; Moral, Ramón; Mencía, Santiago

    2010-04-01

    It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

    International Nuclear Information System (INIS)

    Schellhammer, F.

    2003-01-01

    Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 ± 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations

  10. Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

    Energy Technology Data Exchange (ETDEWEB)

    Schellhammer, F. [St. Katharinen Hospital, Frechen (Germany). Dept. of Radiology

    2003-03-01

    Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 {+-} 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations.

  11. Comprehensive cardiopulmonary life support (CCLS for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2017-01-01

    Full Text Available The cardiopulmonary resuscitation (CPR guideline of comprehensive cardiopulmonary life support (CCLS for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care.

  12. Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: a cross-sectional survey of Victorians.

    Science.gov (United States)

    Bray, Janet E; Smith, Karen; Case, Rosalind; Cartledge, Susie; Straney, Lahn; Finn, Judith

    2017-04-01

    To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  13. Rates of cardiopulmonary resuscitation training in the United States.

    Science.gov (United States)

    Anderson, Monique L; Cox, Margueritte; Al-Khatib, Sana M; Nichol, Graham; Thomas, Kevin L; Chan, Paul S; Saha-Chaudhuri, Paramita; Fosbol, Emil L; Eigel, Brian; Clendenen, Bill; Peterson, Eric D

    2014-02-01

    Prompt bystander cardiopulmonary resuscitation (CPR) improves the likelihood of surviving an out-of-hospital cardiac arrest. Large regional variations in survival after an out-of-hospital cardiac arrest have been noted. To determine whether regional variations in county-level rates of CPR training exist across the United States and the factors associated with low rates in US counties. We used a cross-sectional ecologic study design to analyze county-level rates of CPR training in all US counties from July 1, 2010, through June 30, 2011. We used CPR training data from the American Heart Association, the American Red Cross, and the Health & Safety Institute. Using multivariable logistic regression models, we examined the association of annual rates of adult CPR training of citizens by these 3 organizations (categorized as tertiles) with a county's geographic, population, and health care characteristics. Completion of CPR training. Rate of CPR training measured as CPR course completion cards distributed and CPR training products sold by the American Heart Association, persons trained in CPR by the American Red Cross, and product sales data from the Health & Safety Institute. RESULTS During the study period, 13.1 million persons in 3143 US counties received CPR training. Rates of county training ranged from 0.00% to less than 1.29% (median, 0.51%) in the lower tertile, 1.29% to 4.07% (median, 2.39%) in the middle tertile, and greater than 4.07% or greater (median, 6.81%) in the upper tertile. Counties with rates of CPR training in the lower tertile were more likely to have a higher proportion of rural areas (adjusted odds ratio, 1.12 [95% CI, 1.10-1.15] per 5-percentage point [PP] change), higher proportions of black (1.09 [1.06-1.13] per 5-PP change) and Hispanic (1.06 [1.02-1.11] per 5-PP change) residents, a lower median household income (1.18 [1.04-1.34] per $10 000 decrease), and a higher median age (1.28 [1.04-1.58] per 10-year change). Counties in the South

  14. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    NARCIS (Netherlands)

    Kalz, Marco

    2013-01-01

    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  15. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience

    OpenAIRE

    L?pez-Herce, Jes?s; Matamoros, Martha M.; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, ?ngel; del Castillo, Jimena; Menc?a, Santiago; Moral, Ram?n; Ordo?ez, Flora; S?nchez, Carlos; Lagos, Lina; Johnson, Mar?a; Mendoza, Ovidio

    2017-01-01

    Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised tea...

  16. Cardiopulmonary resuscitation: Advances

    Directory of Open Access Journals (Sweden)

    William Andrés Vargas-Garzón

    2011-06-01

    Full Text Available Reanimation’s guidelines dictated by the AHA (American Heart Association are the strategies to follow in the envi­ronment of any situation related to cardiac arrest. They are acquired after the analysis of the evidence available in reani­mation from higher to less quality, with the best neurological results. After years of observation, was achieved to establish that survival behind cardiac arrest is, in general, low (6%, except that any witness starts immediately cardiopulmonary resuscitation (CPR maneuvers; therefore, medical personal must know and practice these maneuvers. With these con­siderations, it’s necessary to emphasize in the theoretical training of CPR of all health professional and laity, which guarantee everybody be prepared to emergency system ac­tivation, brain’s preservation and defibrillate to recuperate heart and life. The actual approach that combines compres­sions and defibrillation to closed chest, rescue ventilation and cardio tonic drugs. The guidelines AHA 2010, focus on increase frequency and quality of CPR. The objective of this article is to recognize various changes in these guidelines in cardiopulmonary reanimation and promote the continued education’s importance in reanimation.

  17. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

    DEFF Research Database (Denmark)

    Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte

    2007-01-01

    BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS...... AND RESULTS: We distributed 35,002 resuscitation manikins to pupils (12 to 14 years of age) at 806 primary schools. Using the enclosed 24-minute instructional DVD, they trained in CPR and subsequently used the kit to train family and friends (second tier). They completed a questionnaire on who had trained...... in CPR using the kit. Teachers also were asked to evaluate the project. The incidence of bystander CPR in out-of-hospital cardiac arrest in the months following the project was compared with the previous year. In total, 6947 questionnaires (19.8%) were returned. The 6947 kits had been used to train 17...

  18. Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær

    2017-01-01

    BACKGROUND: School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. METHODS...... to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR...... and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9...

  19. Cardiopulmonary Resuscitation Training for Medical Students in Anesthesiology Rotation in Ardabil Medical University (Iran

    Directory of Open Access Journals (Sweden)

    Kh Isazadehfar

    2009-11-01

    Full Text Available Background and purpose: Cardiopulmonary resuscitation (CPR training for undergraduate medical students has been noted to be poor in the past. Attempts have been made The aim of this study is to determine effect of CPR training in the anesthetic ward to improve knowledge and practice undergraduate medical student of CPR.Methods: A 12 month Educational experimental study with self control was done on all undergraduate medical student (n=30 at the medical university of Ardabil in 2006-2007. During I month of program allthis students have undergone CPR training including basic life support (BLS , advanced cardiac life support (ACLS and practical skills. Data were collected via questionnaire, demographic, pre/post knowledge and practice.Results: After training the acceptable score (good and very good about knowledge of BLS, ACLS and practical skill significantly increased %6.7 to %50 (p=0.0001 , %13.3 to %53.4 (p=0.001 and %3.3 to %100 (p=0.001 respectively. A significant relationship between knowledge of ACLS and practical skills was shown (p=0.005.Conclusion: The CPR training course in anesthetic ward leads to a significant increased in skills and knowledge. Adding this course to undergraduate curriculum of medical students especially in operaticallywards (e.g. Anesthetic ward is essential.Keywords: CARDIOPULMONARY RESUSCITATION; TRAINING; BASIC LIFE SUPPORT; ADVANCED CARDIAC LIFE SUPPORT

  20. Effects of script-based role play in cardiopulmonary resuscitation team training.

    Science.gov (United States)

    Chung, Sung Phil; Cho, Junho; Park, Yoo Seok; Kang, Hyung Goo; Kim, Chan Woong; Song, Keun Jeong; Lim, Hoon; Cho, Gyu Chong

    2011-08-01

    The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group. This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects. Both groups showed significantly higher leadership scores after training (C: 58.2 ± 9.2 vs. 67.2 ± 9.5, p=0.007; S: 57.9 ± 8.1 vs. 65.4 ± 12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1 ± 12.6 vs. S: 7.4 ± 13.7, p=0.715), performance (C: 5.5 ± 11.4 vs. S: 4.7 ± 9.6, p=0.838) and total scores (C: 14.6 ± 20.1 vs. S: 12.2 ± 19.5, p=0.726). Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training.

  1. The effectiveness of ultrabrief and brief educational videos for training lay responders in hands-only cardiopulmonary resuscitation: implications for the future of citizen cardiopulmonary resuscitation training.

    Science.gov (United States)

    Bobrow, Bentley J; Vadeboncoeur, Tyler F; Spaite, Daniel W; Potts, Jerald; Denninghoff, Kurt; Chikani, Vatsal; Brazil, Paula R; Ramsey, Bob; Abella, Benjamin S

    2011-03-01

    Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals. This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P38 mm) than the control group (P<0.0001). Laypersons exposed to very short Hands-Only CPR videos are more likely to attempt CPR and show superior CPR skills than untrained laypersons. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01191736.

  2. Improvement in Trainees' Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training: Cross-Sectional Simulation Study.

    Science.gov (United States)

    Kim, Jong Won; Lee, Jeong Hun; Lee, Kyeong Ryong; Hong, Dae Young; Baek, Kwang Je; Park, Sang O

    2016-08-01

    This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality. Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups. Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased. Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

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

    Science.gov (United States)

    Abelairas-Gómez, Cristian; Barcala-Furelos, Roberto; Szarpak, Łukasz; García-García, Óscar; Paz-Domínguez, Álvaro; López-García, Sergio; Rodríguez-Núñez, Antonio

    2017-01-01

    Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation. To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. 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). 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). 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.

  4. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.

    Science.gov (United States)

    López-Herce, Jesús; Matamoros, Martha M; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, Ángel; Del Castillo, Jimena; Mencía, Santiago; Moral, Ramón; Ordoñez, Flora; Sánchez, Carlos; Lagos, Lina; Johnson, María; Mendoza, Ovidio; Rodriguez, Sandra

    2017-09-12

    To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

  5. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej

    2016-01-01

    OBJECTIVE: Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose...... of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN: A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across...... the interviews. SETTING: 8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals. PARTICIPANTS: The study population...

  6. [Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university].

    Science.gov (United States)

    Boaventura, Ana Paula; Miyadahira, Ana Maria Kazue

    2012-03-01

    Early defibrillation in cardiopulmonary resuscitation (CPR) receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points, in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory) and skill (pratice) for the care of CPR victims.

  7. Cardiopulmonary Resuscitation Training in High School Using Avatars in Virtual Worlds: An International Feasibility Study

    Science.gov (United States)

    Hedman, Leif; Heinrichs, LeRoy; Youngblood, Patricia; Felländer-Tsai, Li

    2013-01-01

    Background Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today’s youth (ie, the digital native generation). Objective Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. Methods In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. Results The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0

  8. Basic life support knowledge of secondary school students in cardiopulmonary resuscitation training using a song.

    Science.gov (United States)

    Fonseca Del Pozo, Francisco Javier; Valle Alonso, Joaquin; Canales Velis, Nancy Beatriz; Andrade Barahona, Mario Miguel; Siggers, Aidan; Lopera, Elisa

    2016-07-20

    To examine the effectiveness of a "cardiopulmonary resuscitation song" in improving the basic life support skills of secondary school students. This pre-test/post-test control design study enrolled secondary school students from two middle schools randomly chosen in Córdoba, Andalucia, Spain. The study included 608 teenagers. A random sample of 87 students in the intervention group and 35 in the control group, aged 12-14 years were selected. The intervention included a cardiopulmonary resuscitation song and video. A questionnaire was conducted at three-time points: pre-intervention, one month and eight months post-intervention. On global knowledge of cardiopulmonary resuscitation, there were no significant differences between the intervention group and the control group in the trial pre-intervention and at the month post-intervention. However, at 8 months there were significant differences with a p-value = 0.000 (intervention group, 95% CI: 6.39 to 7.13 vs. control group, 95% CI: 4.75 to 5.92), F(1,120)=16.644, p=0.000). In addition, significant differences about students' basic life support knowledge about chest compressions at eight months post-intervention (F(1,120)=15.561, p=0.000) were found. Our study showed that incorporating the song component in the cardiopulmonary resuscitation teaching increased its effectiveness and the ability to remember the cardiopulmonary resuscitation algorithm. Our study highlights the need for different methods in the cardiopulmonary resuscitation teaching to facilitate knowledge retention and increase the number of positive outcomes after sudden cardiac arrest.

  9. Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: an international feasibility study.

    Science.gov (United States)

    Creutzfeldt, Johan; Hedman, Leif; Heinrichs, LeRoy; Youngblood, Patricia; Felländer-Tsai, Li

    2013-01-14

    Approximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today's youth (ie, the digital native generation). Our main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training. In this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables. The participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, Pinternational

  10. Anaesthetists' knowledge of cardiopulmonary resuscitation | Ogboli ...

    African Journals Online (AJOL)

    Background: Cardio-Pulmonary Resuscitation (CPR) is an integral part of an anaesthetist's knowledge and practice. In Nigeria, these skills are taught mainly during medical school and postgraduate training. Objectives: The study sought to assess the knowledge of anaesthetists about CPR. Methodology: A structured ...

  11. New thoughts on cardiopulmonary resuscitation.

    Science.gov (United States)

    Evans, A T

    1999-05-01

    The results of cardiopulmonary resuscitation (CPR) have been distressingly poor when one considers the amount of research in this field since 1960. Accordingly, some improvements to present protocols have been suggested. Some of the suggestions can be applied by practicing veterinarians to increase the success rate for external chest massage. In addition, veterinarians are encouraged to switch to internal cardiac massage early in the resuscitation period.

  12. Cardiopulmonary resuscitation and oxygen therapy.

    Science.gov (United States)

    Marks, S L

    1999-07-01

    Cardiopulmonary resuscitation and oxygen therapy are often necessary procedures done in veterinary practice. There are variations in CPR technique, especially in cardiac life support. Oxygen therapy can be an important adjunctive therapy in emergency and critical care medicine. The techniques used for oxygen administration differ depending on the medical problem and the animal.

  13. Death before disco: the effectiveness of a musical metronome in layperson cardiopulmonary resuscitation training.

    Science.gov (United States)

    Hafner, John W; Jou, Andrew C; Wang, Huaping; Bleess, Brandon B; Tham, Stephanie K

    2015-01-01

    A novel musical memory aid has been proposed for aiding laypersons in complying with the American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines of 100 compressions per minute (cpm). This study tested usefulness of such a memory aid to improve layperson long-term compliance with CPR compression rate guidelines. A prospective randomized controlled trial was conducted using CPR-untrained laypersons. Subjects received either a standard CPR educational experience (AHA Heartsaver® CPR class) or an experimental CPR educational experience (AHA Heartsaver® CPR class augmented with a musical metronome). Experimental group subjects were taught to perform compressions to the cadence of a pop music song (The Bee Gees "Stayin' Alive"; Saturday Night Fever, The Original Movie Soundtrack; Polygram International Music, 1977) with a tempo of 100 beats/min. Compression rates, depth of compressions, and correct compressions were measured initially and upon retesting ≥6 weeks post-training. Control subjects had a higher mean compression rate both immediately (121 [standard deviation {SD} = 21] vs. 109 [SD = 15] cpm; 95% confidence interval [CI] of mean difference 4-19; p = 0.002) and at follow-up (120 [SD = 20] vs. 111 [SD = 13] cpm; 95% CI of mean difference 2-16; p = 0.014). Compression rates stratified to 100-120 cpm demonstrated no difference between groups initially (39% vs. 48%; p = 0.382), but more experimental subjects maintained these rates at follow-up (43% vs. 74%; p = 0.003). Subjects trained to use a musical metronome more often maintained a compression rate of 100-120 cpm at ≥6-week follow-up, suggesting the memory aid may improve long-term guideline adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Cardiopulmonary resuscitation: current recommendations.

    Science.gov (United States)

    Robello, C D; Crowe, D T

    1989-11-01

    Early recognition of CPA is the key to its successful management. For resuscitation to be managed successfully, effective forward blood flow must be established at the onset of the arrest. In our clinical experience, we have found that the Doppler unit allows us to assess the effectiveness of cerebral perfusion better than any other method of blood pressure evaluation. If, by Doppler monitoring results, cerebral perfusion is found to be poor, blood flow may be mechanically improved by instituting high dose epinephrine therapy and interposed abdominal counter-pressure techniques. There is an understandable reluctance on the part of many veterinarians to enter the chest in the course of CPR. Unfortunately, this delay in performing internal compressions is often the reason that open-chest CPR is deemed ineffective by so many practitioners. If external chest CPR is not effective within 1 to 2 min (maximum) of its initiation, an emergency thoracotomy and direct cardiac massage should be performed. We know that perfusion pressure increases three to five times with open versus closed-chest CPR. This improvement in perfusion with direct cardiac massage is due, in part, to the absence of venous pressure elevations created during external chest compression. It follows that better coronary and cerebral blood flow will result in better resuscitation when direct cardiac massage is performed early. The "bottom line" in CPR is successful resuscitation of the patient with resultant good neurologic function. It is hoped that through the use of these techniques and new cytoprotective drugs, the survival rate will rise.

  15. Current issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Sayre, Michael R; Swor, Robert; Pepe, Paul E; Overton, Jerry

    2003-01-01

    Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome. In current EMS dispatch practice, traditional cardiopulmonary resuscitation (CPR) instructions are given when needed to bystanders who report a possible cardiac arrest. Recent literature has shown that in certain circumstances, CPR instructions involving chest compressions alone may be given more quickly and can yield an equivalent, if not better, chance of survival. Although this practice is controversial, the general consensus is that any CPR is better than none at all. Therefore, telephone CPR protocols that recommend the immediate initiation of chest compressions may be preferred, particularly for callers who have no previous training in CPR.

  16. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the

  17. The effect of formal training of cardiopulmonary resuscitation (CPR skills on medical students perceived self-sufficiency

    Directory of Open Access Journals (Sweden)

    Shaghaghi A

    2004-07-01

    Full Text Available Background: Experience of cardiopulmonary resuscitation (CPR in real clinical setting is not easily possible for all medical students. Purpose: To assess medical student perceived self-sufficiency on three procedural skill on internship courses after they had taken a training course in clerkship period. Methods: Forty three medical students who had attended a workshop on CPR, tracheal intubations and venopuncture answered the questionnaires on their perceived self-sufficiency in performing these procedures after serving a few months as interns. Results: The mean score for perceived self-sufficiency (PSS was 75.84 (±18.63.Thre were a high correlation between the score given for the applicability of training in real life situation and the stress reduction scores on first time performing the procedure. Conclusion: The high degree of correlation between PSS scores and applicability scores, may warrant the consideration of new methods in procedural skills. Keywords: SKILL TRAINING, CPR TRAINING, PERCEIVED SELF-SUFFICIENCY

  18. Should family members witness cardiopulmonary resuscitation?

    Science.gov (United States)

    Mottillo, Salvatore; Delaney, J Scott

    2014-11-01

    What is the effect of family presence during cardiopulmonary resuscitation on family members and the medical team? Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368:1008-18. The authors sought to determine whether systematically offering relatives the option to be present during cardiopulmonary resuscitation increases the proportion of relatives with posttraumatic stress disorder-related symptoms after 90 days. Secondary outcomes included the presence of anxiety and depression symptoms in relatives, the effect of family presence on medical efforts at resuscitation, the well-being of the medical team, and the occurrence of medicolegal claims.

  19. A national survey of prevalence of cardiopulmonary resuscitation training and knowledge of the emergency number in Ireland.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-07-06

    AIM: The aim of this survey was to establish prevalence of cardiopulmonary resuscitation (CPR) training within the last 5 years and reasons preventing training and initiation of CPR in Ireland as well as awareness of the emergency numbers. METHODS: An in-home omnibus survey was undertaken in 2008 with quota sampling reflecting the age, gender, social class and geography of Ireland. RESULTS: Of the 974 respondents, 23.5% had undergone CPR training in the previous 5 years with lower social class and age 65 years and older significantly less likely to be trained. The workplace was both a major source of awareness as well as training for those trained. In the untrained group lack of awareness of the need for CPR training was the most significant reason for non-training. Cost was not cited as a barrier. 88.9% of people gave a correct emergency number with geographical variation. Notably, the European emergency number 112 was not well known. CONCLUSION: Previous Irish and American population targets for CPR training have been surpassed in Ireland in 2008. New internationally agreed targets are now required. Meanwhile older people and those in lower socio-economic groups should be targeted for training. Awareness of at least one emergency number is very high in Ireland. Some geographical variation was found and this should be studied further.

  20. Cardiopulmonary resuscitation in hospitalized infants.

    Science.gov (United States)

    Hornik, Christoph P; Graham, Eric M; Hill, Kevin; Li, Jennifer S; Ofori-Amanfo, George; Clark, Reese H; Smith, P Brian

    2016-10-01

    Hospitalized infants requiring cardiopulmonary resuscitation (CPR) represent a high-risk group. Recent data on risk factors for mortality following CPR in this population are lacking. We hypothesized that infant demographic characteristics, diagnoses, and levels of cardiopulmonary support at the time of CPR requirement would be associated with survival to hospital discharge following CPR. Retrospective cohort study. All infants receiving CPR on day of life 2 to 120 admitted to 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We collected data on demographics, interventions, center volume, and death prior to NICU discharge. We evaluated predictors of death after CPR using multivariable logistic regression with generalized estimating equations to account for clustering of the data by center. Our cohort consisted of 2231 infants receiving CPR. Of these, 1127 (51%) survived to hospital discharge. Lower gestational age, postnatal age, 5-min APGAR, congenital anomaly, and markers of severity of illness were associated with higher mortality. Mortality after CPR did not change significantly over time (Cochran-Armitage test for trend p=0.35). Mortality following CPR in infants is high, particularly for less mature, younger infants with congenital anomalies and those requiring cardiopulmonary support prior to CPR. Continued focus on at risk infants may identify targets for CPR prevention and improve outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Training neonatal cardiopulmonary resuscitation: can it be improved by playing a musical prompt? A pilot study.

    Science.gov (United States)

    Dold, Simone K; Schmölzer, Georg M; Kelm, Marcus; Davis, Peter G; Schmalisch, Gerd; Roehr, Charles Christoph

    2014-03-01

    Effective neonatal cardiopulmonary resuscitation (CPR) requires 3:1 coordinated manual inflations (MI) and chest compressions (CC). We hypothesized that playing a musical prompt would help coordinate CC and MI during CPR. In this pilot trial we studied the effect the "Radetzkymarsch" (110 beats per minute) on neonatal CPR. Thirty-six medical professionals performed CPR on a neonatal manikin. CC and MI were recorded with and without the music played, using a respiratory function monitor and a tally counter. Statistical analysis included Wilcoxon test. Without music, the median (interquartile range) rate of CC was 115 (100 to 129) per minute and the rate of MI was 38 (32 to 42) per minute. When listening to the auditory prompt, the rate of CC decreased significantly to 96 (96 to 100) per minute (p = 0.002) and the rate of MI to 32 (30 to 34) per minute (p = 0.001). The interquartile range of interoperator variability decreased up to 86%. Listening to an auditory prompt improved compliance with the recommended delivery rates of CC and MI during neonatal CPR. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Ethical considerations behind the limitation of cardiopulmonary resuscitation in Hungary--the role of education and training.

    Science.gov (United States)

    Elo, Gábor; Diószeghy, Csaba; Dobos, Márta; Andorka, Mátyás

    2005-01-01

    Although the long term success of cardiopulmonary resuscitation (CPR) is still less than hoped for, its value cannot be questioned when carried out appropriately in selected cases. Resuscitation frequently brings only short-term success, and several patients suffer severe consequences also causing an economic, medical and ethical burden to society. The issue of limitation of resuscitation, including Do Not Attempt Resuscitation (DNAR) and the termination of resuscitation has been surveyed in many European countries using a structured questionnaire. In Hungary no such comprehensive study has been conducted yet. The goal of this investigation was to recognise the ethical factors limiting resuscitation in Hungary. We contacted 72 doctors personally during 2003, who were working actively at an intensive care unit (ICU) and asked them to answer a structured questionnaire in strict anonymity. We investigated the role of different ethical issues in beginning and suspending resuscitation efforts in conjunction with medical experience, sex, ideology, and education using a five point visual analogue scale. The answers given were categorised to autonomy, futility, obtainable quality of life, resource utilization, and to "another" category detailed later on. The questionnaire and the plan of this investigation was approved by the Semmelweis Medical University's Ethical Committee (SE-TUKEB 109/2003). The decision not to attempt resuscitation was mostly dictated by the opinion of the head of department and the doctor in charge of the patient (3.53 +/- 1.30), and after this the presumed obtainable quality of life (3.13 +/- 1.40), objective futility (3.11 +/- 0.94), and patient autonomy (2.02 +/- 1.63). The other objective (0.57 +/- 1.59), and subjective (1.04 +/- 1.21) factors, as well as resource utilization (0.29 +/- 0.66) played a less important role. The decision to terminate resuscitation efforts was mostly dictated by the objective futility criteria (3.39 +/- 0

  3. A pilot study of flipped cardiopulmonary resuscitation training : Which items can be self-trained?

    NARCIS (Netherlands)

    Van Raemdonck, Veerle; Aerenhouts, Dirk; Monsieurs, Koen; De Martelaer, Kristine

    2017-01-01

    Objective: This study evaluated self-trained basic life support (BLS) skills acquired from an e-learning platform to design a complementary in-class training approach. Design: In total, 41 students (15–17 years, 29 men) participated in a pilot study on self-training in BLS. After 6 weeks, a

  4. Innovative cardiopulmonary resuscitation and automated external defibrillator programs in schools: Results from the Student Program for Olympic Resuscitation Training in Schools (SPORTS) study.

    Science.gov (United States)

    Vetter, Victoria L; Haley, Danielle M; Dugan, Noreen P; Iyer, V Ramesh; Shults, Justine

    2016-07-01

    Bystander cardiopulmonary resuscitation (CPR) rates are low. Our study objective was to encourage Philadelphia high school students to develop CPR/AED (automated external defibrillator) training programs and to assess their efficacy. The focus was on developing innovative ways to learn the skills of CPR/AED use, increasing willingness to respond in an emergency, and retention of effective psychomotor resuscitation skills. Health education classes in 15 Philadelphia School District high schools were selected, with one Control and one Study Class per school. Both completed CPR/AED pre- and post-tests to assess cognitive knowledge and psychomotor skills. After pre-tests, both were taught CPR skills and AED use by their health teacher. Study Classes developed innovative programs to learn, teach, and retain CPR/AED skills. The study culminated with Study Classes competing in multiple CPR/AED skills events at the CPR/AED Olympic event. Outcomes included post-tests, Mock Code, and presentation scores. All students' cognitive and psychomotor skills improved with standard classroom education (p<0.001). Competition with other schools at the CPR/AED Olympics and the development of their own student-directed education programs resulted in remarkable retention of psychomotor skill scores in the Study Class (88%) vs the Control Class (79%) (p<0.001). Olympic participants averaged 93.1% on the Mock Code with 10 of 12 schools ≥94%. Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code with remarkable psychomotor skill retention, potentially empowering a new generation of effectively trained CPR bystanders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Family presence during cardiopulmonary resuscitation.

    Science.gov (United States)

    Jabre, Patricia; Belpomme, Vanessa; Azoulay, Elie; Jacob, Line; Bertrand, Lionel; Lapostolle, Frederic; Tazarourte, Karim; Bouilleau, Guillem; Pinaud, Virginie; Broche, Claire; Normand, Domitille; Baubet, Thierry; Ricard-Hibon, Agnes; Istria, Jacques; Beltramini, Alexandra; Alheritiere, Armelle; Assez, Nathalie; Nace, Lionel; Vivien, Benoit; Turi, Laurent; Launay, Stephane; Desmaizieres, Michel; Borron, Stephen W; Vicaut, Eric; Adnet, Frederic

    2013-03-14

    The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial. We enrolled 570 relatives of patients who were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims. In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medicolegal claims. Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).

  6. Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World.

    Science.gov (United States)

    Creutzfeldt, Johan; Hedman, Leif; Felländer-Tsai, Li

    2016-12-16

    Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. The objective of this study was to reach a better understanding of the learners' reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students' perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Four categories characterizing the students' experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.

  7. Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students’ Experiences Using a Multiplayer Virtual World

    Science.gov (United States)

    Hedman, Leif; Felländer-Tsai, Li

    2016-01-01

    Background Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance. PMID:27986645

  8. Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark: A Nationwide Survey.

    Science.gov (United States)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær; Tjørnhøj-Thomsen, Tine; Wissenberg, Mads; Lippert, Freddy Knudsen; Weeke, Peter; Gislason, Gunnar Hilmar; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

    2017-03-14

    School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9.68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1.57-2.76]). Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. © 2017 The Authors. Published on behalf of the

  9. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial

    OpenAIRE

    Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

    2016-01-01

    Objectives To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Design Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Setting Participants were recruited from a medical school and two paramedic schools of South Korea. Participants 42 senior students of a medical school and two pa...

  10. Public knowledge and attitudes towards cardiopulmonary resuscitation in Hong Kong: telephone survey.

    Science.gov (United States)

    Chair, S Y; Hung, Maria S Y; Lui, Joseph C Z; Lee, Diana T F; Shiu, Irene Y C; Choi, K C

    2014-04-01

    To investigate the public's knowledge and attitudes about cardiopulmonary resuscitation in Hong Kong. Cross-sectional telephone survey. Hong Kong. Hong Kong residents aged 15 to 64 years. The knowledge and attitudes towards cardiopulmonary resuscitation. Among the 1013 respondents, only 214 (21%) reported that they had received cardiopulmonary resuscitation training. The majority (72%) of these trained respondents had had their latest training more than 2 years earlier. The main reasons for not being involved in cardiopulmonary resuscitation training included lack of time or interest, and "not necessary". People with full-time jobs and higher levels of education were more likely to have such training. Respondents stating they had received cardiopulmonary resuscitation training were more willing to try it if needed at home (odds ratio=3.3; 95% confidence interval, 2.4-4.6; Pcase of emergencies. Overall cardiopulmonary resuscitation knowledge of the respondents was low (median=1, out of 8). Among all the respondents, only four of them (0.4%) answered all the questions correctly. Knowledge of cardiopulmonary resuscitation was still poor among the public in Hong Kong and the percentage of population trained to perform it was also relatively low. Efforts are needed to promote educational activities and explore other approaches to skill reinforcement and refreshment. Besides, we suggest enacting laws to protect bystanders who offer cardiopulmonary resuscitation, and incorporation of relevant training course into secondary school and college curricula.

  11. Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.

    Science.gov (United States)

    Swor, Robert; Compton, Scott

    2004-01-01

    Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged 50 years was 785,040 dollars. Using a strategy of training only those cost of 53,383 dollars per life saved. Using these assumptions, current CPR training strategy is not a cost

  12. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  13. Impact of basic life-support training on the attitudes of health-care workers toward cardiopulmonary resuscitation and defibrillation.

    Science.gov (United States)

    Abolfotouh, Mostafa A; Alnasser, Manal A; Berhanu, Alamin N; Al-Turaif, Deema A; Alfayez, Abdulrhman I

    2017-09-22

    Cardiopulmonary resuscitation (CPR) increases the probability of survival of a person with cardiac arrest. Repeating training helps staff retain knowledge in CPR and in use of automated external defibrillators (AEDs). Retention of knowledge and skills during and after training in CPR is difficult and requires systematic training with appropriate methodology. The aim of this study was to determine the effect of basic life-support (BLS) training on the attitudes of health-care providers toward initiating CPR and on use of AEDs, and to investigate the factors that influence these attitudes. A quasi-experimental study was conducted in two groups: health-care providers who had just attended a BLS-AED course (post-BLS group, n = 321), and those who had not (pre-BLS group, n = 421). All participants had previously received BLS training. Both groups were given a validated questionnaire to evaluate the status of life-support education and certification, attitudes toward use of CPR and AED and concerns regarding use of CPR and AED. Multiple linear regression analyses were applied to identify significant predictors of the attitude and concern scores. Overall positive attitudes were seen in 53.4% of pre-BLS respondents and 64.8% of post-BLS respondents (χ 2  = 9.66, p = 0.002). Positive attitude was significantly predicted by the recent completion of BLS training (β = 5.15, p < 0.001), the number of previous BLS training courses (β = 2.10, p = 0.008) and previous exposure to cardiac-arrest cases (β = 3.44, p = 0.018), as well as by low concern scores, (β = -0.09, p < 0.001). Physicians had significantly lower concern scores than nurses (β = -10.45, p = 0.001). Concern scores decreased as the duration of work experience increased (t = 2.19, p = 0.029). Repeated educational programs can improve attitudes toward CPR performance and the use of AEDs. Training that addressed the concerns of health-care workers could further improve these

  14. Knowledge and practice of cardiopulmonary resuscitation among ...

    African Journals Online (AJOL)

    Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors. Methods: Questionnaires were distributed randomly to doctors in a Nigerian University Teaching ...

  15. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej

    2016-01-01

    of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN: A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across...... comprised 25 participants, 9 school leadership members and 16 teachers. RESULTS: School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless...... teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted...

  16. The importance of cardiopulmonary resuscitation quality.

    Science.gov (United States)

    Abella, Benjamin S

    2013-06-01

    Cardiopulmonary resuscitation (CPR) is a fundamental component of initial care for the victim of cardiac arrest. In the past few years, increasing quantitative evidence has demonstrated that survival from cardiac arrest is dependent on the quality of delivered CPR. This review will focus on this body of evidence and on a range of practical approaches to improving CPR performance. A number of strategies to improve CPR quality have been evaluated recently, during both prehospital and in-hospital cardiac arrest care. These strategies have included the use of real-time CPR sensing and feedback, the employment of physiologic monitoring such as end-tidal CO(2) measurement and the use of metronome prompting. The use of mechanical CPR devices to avoid the challenges of manual CPR performance has also represented a topic of great current interest. Additional approaches have focused on both prearrest training (e.g. high-fidelity simulation education and CPR refreshers) and postarrest training (e.g. debriefing). A number of strategies have been evaluated to improve CPR performance. While many questions remain surrounding the relative value of each approach, it is likely that combinations of these methods may be useful in a variety of care settings to improve care for cardiac arrest victims.

  17. Comparison of Cardiopulmonary Resuscitation Quality Between Standard Versus Telephone-Basic Life Support Training Program in Middle-Aged and Elderly Housewives: A Randomized Simulation Study.

    Science.gov (United States)

    Kim, Tae Han; Lee, Yu Jin; Lee, Eui Jung; Ro, Young Sun; Lee, KyungWon; Lee, Hyeona; Jang, Dayea Beatrice; Song, Kyoung Jun; Shin, Sang Do; Myklebust, Helge; Birkenes, Tonje Søraas

    2018-02-01

    For cardiac arrests witnessed at home, the witness is usually a middle-aged or older housewife. We compared the quality of cardiopulmonary resuscitation (CPR) performance of bystanders trained with the newly developed telephone-basic life support (T-BLS) program and those trained with standard BLS (S-BLS) training programs. Twenty-four middle-aged and older housewives without previous CPR education were enrolled and randomized into two groups of BLS training programs. The T-BLS training program included concepts and current instruction protocols for telephone-assisted CPR, whereas the S-BLS training program provided training for BLS. After each training course, the participants simulated CPR and were assisted by a dispatcher via telephone. Cardiopulmonary resuscitation quality was measured and recorded using a mannequin simulator. The primary outcome was total no-flow time (>1.5 seconds without chest compression) during simulation. Among 24 participants, two (8.3%) who experienced mechanical failure of simulation mannequin and one (4.2%) who violated simulation protocols were excluded at initial simulation, and two (8.3%) refused follow-up after 6 months. The median (interquartile range) total no-flow time during initial simulation was 79.6 (66.4-96.9) seconds for the T-BLS training group and 147.6 (122.5-184.0) seconds for the S-BLS training group (P < 0.01). Median cumulative interruption time and median number of interruption events during BLS at initial simulation and 6-month follow-up simulation were significantly shorter in the T-BLS than in the S-BLS group (1.0 vs. 9.5, P < 0.01, and 1.0 vs. 10.5, P = 0.02, respectively). Participants trained with the T-BLS training program showed shorter no-flow time and fewer interruptions during bystander CPR simulation assisted by a dispatcher.

  18. Obstacles to bystander cardiopulmonary resuscitation in Japan.

    Science.gov (United States)

    Shibata, K; Taniguchi, T; Yoshida, M; Yamamoto, K

    2000-05-01

    bystander cardiopulmonary resuscitation (CPR) is performed infrequently in Japan. We conducted this study to identify Japanese attitudes toward the performance of bystander CPR. participants were asked about their willingness to perform CPR with varying scenarios and CPR techniques (mouth-to-mouth ventilation plus chest compression (MMV plus CC) versus chest compression alone (CC)). a total of 1302/1355 individuals completed the questionnaire, including high school students, teachers, emergency medical technicians, medical nurses, and medical students. About 2% of high school students, 3% of teachers, 26% of emergency medical technicians, 3% of medical nurses and 16% of medical students claimed they would 'definitely' perform MMV plus CC on a stranger. However, 21-72% claimed they would prefer the alternative of performing CC alone. Respondents claimed their unwillingness to perform MMV is not due to the fear of contracting a communicable disease, but the lack of confidence in their ability to perform CPR properly. in all categories of respondents, willingness to perform MMV plus CC for a stranger was disappointingly low. Better training in MMV together with teaching awareness that CC alone can be given should be instituted to maximize the number of potential providers of CPR in the community, even in communities where the incidence of HIV is very low.

  19. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  20. The key changes in pediatric and neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Sung, Dyi-Shiang; Hsieh, Kai-Sheng

    2007-01-01

    The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) were changed in 2005. There were some key changes in the recommendations for pediatric basic and advanced life support, and neonatal resuscitation. The key changes included: emphasis on effective compressions (push hard, push fast, allow full chest recoil and minimize interruptions in compressions), a single compression-ventilation ratio (30:2) CPR for all groups of ages (except neonate), confirmation of effective ventilations, medication given and defibrillator charged without interruption of CPR, not recommended to routine tracheal suction the vigorous meconium-stained baby in newborn resuscitation, etc. We illustrate the major key changes and hope everyone is well trained to perform high quality CPR.

  1. Certified Basic Life Support Instructors Assess Cardiopulmonary Resuscitation Skills Poorly

    DEFF Research Database (Denmark)

    Hansen, Camilla; Rasmussen, Stinne E; Kristensen, Mette Amalie

    2016-01-01

    quality poorly. Currently no studies have evaluated CPR assessment among certified BLS instructors. The aim of this study was to investigate certified BLS instructors’ assessment of chest compressions and rescue breathing.Methods: Data were collected at BLS courses for medical students at Aarhus...... University, Denmark. In pairs, BLS instructors, certified by the European Resuscitation Council, evaluated each learner in an end-of-course cardiac arrest test. Instructors’ assessments were compared with CPR quality data collected from the resuscitation manikin. Correct chest compressions were defined as ≥2......Introduction: High-quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest. During basic life support (BLS) training, instructors assess CPR skills to enhance learning outcome. Emergency department staff and senior residents have been shown to assess chest compression...

  2. [Family presence during cardiopulmonary resuscitation and other invasive procedures].

    Science.gov (United States)

    Prati, Gabriele; Monti, Massimo

    2010-01-01

    Family presence during patient cardiopulmonary resuscitation and other invasive procedures has been discussed and debated since the early 1990s. Although family presence was nor a well-practiced phenomenon, nor generally accepted, since the early to mid 1990s many American professional organizations have endorsed the idea of family presence. The aim of this study is to identify the policies, preferences, and practices of critical care and emergency personnel for having patients' families present during medical procedures and cardiopulmonary resuscitation. A total of 378 nurses and medical workers filled out a 10-item survey. Among the respondents, nurses tended to disagree more with family presence in comparison to physician. Critical care unit personnel tended to disagree more with family presence in comparison to emergency department personnel and especially pre-hospital care personnel. While 83% of participants disagree with family presence during cardiopulmonary resuscitation, 67% of participant endorse the view that family presence may foster collaboration between family members and staff members. Overall, 92% of participants worked on units without written policies allowing family presence. Training programs aimed at disseminating knowledge about the relational aspects of health care and the development of written policies or guidelines for family presence during medical procedures are recommended.

  3. Cardiopulmonary Resuscitation (CPR): First Aid

    Science.gov (United States)

    ... minutes. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an ... and Research. © 1998-2018 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

  4. Some Medicolegal Aspects of the Russian Cardiopulmonary Resuscitation Protocol

    Directory of Open Access Journals (Sweden)

    V. A. Kuksinsky

    2006-01-01

    Full Text Available The purpose of the study was to analyze the Russian legislation to identify the medicolegal aspects of cardiopulmonary resuscitation, which are most significant for an intensive care anesthesiologist. Statutory acts concerning human health care, including those pertinent to cardiopulmonary resuscitation and those providing for the responsibility of medical workers in some cases were analyzed. A number of discrepancies in various legal acts concerning human death verification and resuscitative measures were identified. The analysis has revealed the aspects of cardiopulmonary resuscitation, which are, from the point of view of legislation, most important for the physician.

  5. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing.

    Science.gov (United States)

    Berg, Robert A; Sutton, Robert M; Holubkov, Richard; Nicholson, Carol E; Dean, J Michael; Harrison, Rick; Heidemann, Sabrina; Meert, Kathleen; Newth, Christopher; Moler, Frank; Pollack, Murray; Dalton, Heidi; Doctor, Allan; Wessel, David; Berger, John; Shanley, Thomas; Carcillo, Joseph; Nadkarni, Vinay M

    2013-10-01

    The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes. Prospective and observational study. Total of 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database. Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute. None. The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87-91% vs 2004-2010: 94-96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004-2010 compared with 2000-2003 (relative risk, 1.08; 95% CI, 1.03-1.13). In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.

  6. Ventilation Strategies during Neonatal Cardiopulmonary Resuscitation

    Science.gov (United States)

    Baik, Nariae; O’Reilly, Megan; Fray, Caroline; van Os, Sylvia; Cheung, Po-Yin; Schmölzer, Georg M.

    2018-01-01

    Approximately, 10–20% of newborns require breathing assistance at birth, which remains the cornerstone of neonatal resuscitation. Fortunately, the need for chest compression (CC) or medications in the delivery room (DR) is rare. About 0.1% of term infants and up to 15% of preterm infants receive these interventions, this will result in approximately one million newborn deaths annually worldwide. In addition, CC or medications (epinephrine) are more frequent in the preterm population (~15%) due to birth asphyxia. A recent study reported that only 6 per 10,000 infants received epinephrine in the DR. Further, the study reported that infants receiving epinephrine during resuscitation had a high incidence of mortality (41%) and short-term neurologic morbidity (57% hypoxic-ischemic encephalopathy and seizures). A recent review of newborns who received prolonged CC and epinephrine but had no signs of life at 10 min following birth noted 83% mortality, with 93% of survivors suffering moderate-to-severe disability. The poor prognosis associated with receiving CC alone or with medications in the DR raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. PMID:29484288

  7. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Kleinman, Monica E; Goldberger, Zachary D; Rea, Thomas; Swor, Robert A; Bobrow, Bentley J; Brennan, Erin E; Terry, Mark; Hemphill, Robin; Gazmuri, Raúl J; Hazinski, Mary Fran; Travers, Andrew H

    2018-01-02

    Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation. © 2017 American Heart Association, Inc.

  8. Time matters--realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian; Ostergaard, Doris

    2014-01-01

    BACKGROUND: The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resu......BACKGROUND: The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation......-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting....... METHODS: This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120...

  9. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial.

    Science.gov (United States)

    Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

    2016-02-12

    To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Participants were recruited from a medical school and two paramedic schools of South Korea. 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Average compression depths were significantly different according to the rate used in training (pmetronome-guided CPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Li, E S; Cheung, P-Y; O'Reilly, M; Aziz, K; Schmölzer, G M

    2015-02-01

    To assess development of fatigue during chest compressions (CCs) in simulated neonatal cardiopulmonary resuscitation (CPR). Prospective randomized manikin crossover study. Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using (i) 3:1 compression:ventilation (C:V) ratio, (ii) continuous CC with asynchronous ventilation (CCaV) at a rate of 90 CC per min and (iii) CCaV at 120 CC per min for a duration of 10 min on a neonatal manikin. Changes in peak pressure (a surrogate of fatigue) and CC rate were continuously recorded and fatigue among groups was compared. Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial. Compared with baseline, a significant decrease in peak pressure was observed after 72, 96 and 156 s in group CCaV-120, CCaV-90 and 3:1 C:V, respectively. CC depth decreased by 50% within the first 3 min during CCaV-120, 30% during CCaV-90 and 20% during 3:1 C:V. Moreover, 3:1 C:V and CCaV were similarly preferred by healthcare professionals. Similarly, 3:1 C:V and CCaV CPR were also fatiguing. We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR.

  11. The Level Of Knowlege Guidelines Cardiopulmonary Resuscitation For Nurses

    OpenAIRE

    Lukešová, Ludmila

    2012-01-01

    The goal of this thesis is to determine the level of theoretical knowledge of the procedures of cardiopulmonary resuscitation of selected non-medical staff members in VFN in Prague. The work is subdivided into a theoretical and a practical part. In the first part I comment on the history of cardiopulmonary resuscitation, the basic and widespread vital support to adults and children and the didactics of CPR. In the second- practical part I compare the theoretical knowledge of CPR of selected n...

  12. "You can also save a life!": children's drawings as a non-verbal assessment of the impact of cardiopulmonary resuscitation training.

    Science.gov (United States)

    Petriş, Antoniu Octavian; Tatu-Chiţoiu, Gabriel; Cimpoeşu, Diana; Ionescu, Daniela Florentina; Pop, Călin; Oprea, Nadia; Ţînţ, Diana

    2017-04-01

    Drawings made by training children into cardiopulmonary resuscitation (CPR) during the special education week called "School otherwise" can be used as non-verbal means of expression and communication to assess the impact of such training. We analyzed the questionnaires and drawings completed by 327 schoolchildren in different stages of education. After a brief overview of the basic life support (BLS) steps and after watching a video presenting the dynamic performance of the BLS sequence, subjects were asked to complete a questionnaire and make a drawing to express main CPR messages. Questionnaires were filled completely in 97.6 % and drawings were done in 90.2 % cases. Half of the subjects had already witnessed a kind of medical emergency and 96.94 % knew the correct "112" emergency phone number. The drawings were single images (83.81 %) and less cartoon strips (16.18 %). Main themes of the slogans were "Save a life!", "Help!", "Call 112!", "Do not be indifferent/insensible/apathic!" through the use of drawings interpretation, CPR trainers can use art as a way to build a better relation with schoolchildren, to connect to their thoughts and feelings and obtain the highest quality education.

  13. Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what...

  14. Cardiopulmonary resuscitation: what cost to cheat death?

    Science.gov (United States)

    Lee, K H; Angus, D C; Abramson, N S

    1996-12-01

    To review the various outcomes from cardiopulmonary resuscitation (CPR), the factors that influence these outcomes, the costs associated with CPR, and the application of cost-analyses to CPR. Data used to prepare this article were drawn from published articles and work in progress. Articles were selected for their relevance to the subjects of CPR and cost-analysis by MEDLINE keyword search. The authors extracted all applicable data from the English literature. Cost-analysis studies of CPR programs are limited by the high variation in resources consumed and attribution of cost to these resources. Furthermore, cost projections have not been adjusted to reflect patient-dependent variation in outcome. Variation in the patient's underlying condition, presenting cardiac rhythm, time to provision of definitive CPR, and effective perfusion all influence final outcome and, consequently, influence the cost-effectiveness of CPR programs. Based on cost data from previous studies, preliminary estimates of the cost-effectiveness of CPR programs for all 6-month survivors of a large international multicenter collaborative trial are $406,605.00 per life saved (range $344,314.00 to $966,759.00), and $225,892.00 per quality-adjusted-life-year (range $191,286.00 to $537,088.00). Reported outcome from CPR has varied from reasonable rates of good recovery, including return to full employment to 100% mortality. Appropriate CPR is encouraged, but continued widespread application appears extremely expensive.

  15. 30: 2: A Game Designed to Promote the Cardiopulmonary Resuscitation Protocol

    OpenAIRE

    Boada, Imma; Rodriguez-Benitez, Antonio; Garcia-Gonzalez, Juan Manuel; Thió i Fernández de Henestrosa, Santiago; Sbert, Mateu

    2016-01-01

    Cardiopulmonary resuscitation (CPR) is a first-aid key survival technique used to stimulate breathing and keep blood flowing to the heart. Its effective administration can significantly increase the survival chances of cardiac arrest victims. We propose 30 : 2, a videogame designed to introduce the main steps of the CPR protocol. It is not intended for certification and training purpose. Driven by the 2010 European Resuscitation Council guidelines we have designed a game composed of eight min...

  16. delta-Opioid-induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation.

    Science.gov (United States)

    Fang, Xiangshao; Tang, Wanchun; Sun, Shijie; Weil, Max Harry

    2006-12-01

    Cardiac arrest and cardiopulmonary resuscitation is an event of global myocardial ischemia and reperfusion, which is associated with severe postresuscitation myocardial dysfunction and fatal outcome. Evidence has demonstrated that mammalian hibernation is triggered by cyclic variation of a delta-opiate-like compound in endogenous serum, during which the myocardial metabolism is dramatically reduced and the myocardium tolerates the stress of ischemia and reperfusion without overt ischemic and reperfusion injury. Previous investigations also proved that the delta-opioid agonist elicited the cardioprotection in a model of regional ischemic intact heart or myocyte. Accordingly, we were prompted to search for an alternative intervention of pharmacologically induced myocardial hibernation that would result in rapid reductions of myocardial metabolism and therefore minimize the myocardial ischemic and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. Prospective, controlled laboratory study. University-affiliated research laboratory. In the series of studies performed in the established rat and pig model of cardiac arrest and cardiopulmonary resuscitation, the delta-opioid receptor agonist, pentazocine, was administered during ventricular fibrillation. : The myocardial metabolism reflected by the concentration of lactate, or myocardial tissue PCO2 and PO2, is dramatically reduced during cardiac arrest and cardiopulmonary resuscitation. These are associated with less severe postresuscitation myocardial dysfunction and longer duration of postresuscitation survival. delta-Opioid-induced pharmacologic myocardial hibernation is an option to minimize the myocardial ischemia and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation.

  17. Outcome of cardiopulmonary resuscitation - predictors of survival

    International Nuclear Information System (INIS)

    Ishtiaq, O.; Iqbal, M.; Zubair, M.; Qayyum, R.; Adil, M.

    2008-01-01

    To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95% CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95% CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95% CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95% CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95% CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95% CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95% CI = 0.85-0.96, p-value = 0.001), and total atropine dose given during CPR (odds ratio = 0.68, 95% CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio 8.69, 95% CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95% CI = 0.87-0.98, p-value = 0.01) were associated with survival at

  18. Effects of Age, Gender, School Class on Cardiopulmonary Resuscitation Skills of Nigerian Secondary School Students

    Science.gov (United States)

    Onyeaso, Adedamola Olutoyin; Onyeaso, Chukwudi Ochi

    2016-01-01

    Background: The need for training of schoolchildren on cardiopulmonary resuscitation (CPR) as potential bystander CPR providers is growing globally but Nigeria is still behind and lacks basic necessary data. Purpose: The purpose of this study was to investigate the effects of age, gender and school class on CPR skills of Nigerian secondary school…

  19. Efficacy of cardiopulmonary resuscitation performed in a dental chair.

    Science.gov (United States)

    Lepere, A J; Finn, J; Jacobs, I

    2003-12-01

    Within the dental setting, historically there has been some concern as to whether cardiopulmonary resuscitation (CPR) can be performed effectively in the dental chair. This study tested the hypothesis that there is no difference in the efficacy of CPR performed in the dental chair or on the floor. Four cycles of two-person CPR were performed by three health professionals on a manikin positioned alternately on the floor and in a dental chair. Ventilation was performed using a Laerdal pocket mask, without oxygen supplementation. Compression and ventilation performance was recorded using a computerized manikin skill meter. Each of the participants was able to achieve a mean cardiac compression depth of between 41 and 50cm, irrespective of the CPR surface. The only statistically significant difference found in expired air resuscitation (EAR) and external cardiac compression performance was that 37 per cent of ventilations performed on the floor were deemed to be too shallow, compared to only 15 per cent in the dental chair (p=0.001). It is possible for those trained in basic life support to perform CPR effectively in the dental chair. Each of the participants agreed that CPR, in particular EAR, was easier to perform when the manikin was in the dental chair compared with the floor. Dentists are encourage to regularly update their CPR knowledge and skills, including the practice of CPR in the dental chair.

  20. Family presence during cardiopulmonary resuscitation and invasive procedures in children.

    Science.gov (United States)

    Ferreira, Cristiana Araújo G; Balbino, Flávia Simphronio; Balieiro, Maria Magda F G; Mandetta, Myriam Aparecida

    2014-03-01

    To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Most articles were published in the United States (80%), in Medicine and Nursing (46%), and were surveys (72%) with healthcare team members (67%) as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a) to develop a sensitizing program for healthcare team; b) to educate the healthcare team to include the family in these circumstances; c) to develop a written institutional policy; d) to ensure the attendance of family's needs. Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  1. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    Directory of Open Access Journals (Sweden)

    Cristiana Araujo G. Ferreira

    2014-03-01

    Full Text Available Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Data synthesis : Most articles were published in the United States (80%, in Medicine and Nursing (46%, and were surveys (72% with healthcare team members (67% as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a to develop a sensitizing program for healthcare team; b to educate the healthcare team to include the family in these circumstances; c to develop a written institutional policy; d to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

  2. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

    2004-01-01

    The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

  3. Cardiopulmonary resuscitation during spaceflight: examining the role of timing devices.

    Science.gov (United States)

    Hurst, Victor W; Whittam, Sarah W; Austin, Paul N; Branson, Richard D; Beck, George

    2011-08-01

    The majority of International Space Station (ISS) astronauts represent nonmedical professions. In order to serve as Crew Medical Officers (CMO), future crewmembers receive 40-70 h of medical training within 18 mo before missions, including cardiopulmonary resuscitation (CPR) per the Guidelines of the American Heart Association. CPR compliance with the Guidelines is known to vary even among trained clinicians, let alone minimally trained caregivers (e.g., bystanders, nonphysician astronauts). The purpose of this study was to evaluate the effect of timing devices, including audible metronomic tones, on CPR performed by nonmedical personnel, specifically 40 astronaut analogues trained in a fashion and within a timeframe similar to an ISS astronaut. Twenty bystander pairs performed two-person CPR for 4 min on a simulated cardiac arrest patient using three interventions: 1) CPR with no timing devices; 2) CPR with metronomic tones for chest compressions; and 3) CPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Each CPR performance was evaluated for compliance with the (then current) 2000 AHA Guidelines. Numbers of breaths and compressions significantly deviated from target values in the first two interventions (38 and 42 breaths vs. target of 32 breaths; 282 and 318 compressions vs. target of 240 compressions); the use of timing devices for both components of CPR resulted in significant improvement (32 breaths and 231 compressions). CPR timing devices that coordinate both breaths and compressions improve compliance of astronaut analogue rescuers with CPR guidelines, and may improve overall CPR performance and outcome.

  4. Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan.

    Science.gov (United States)

    Taniguchi, Takumi; Omi, Wataru; Inaba, Hideo

    2007-10-01

    Early initiation of bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. The importance of bystander CPR is attracting more interest, and there has been an increase in attendance at CPR training courses in Japan. However, there have been few reports regarding Japanese attitudes toward the performance of bystander CPR. The present study was performed to identify current Japanese attitudes toward bystander CPR compared to our previous study performed in 1998. Between February and March 2006, participants were asked about their willingness to perform CPR in five varying scenarios, i.e., performing CPR on a stranger, a trauma patient, a child, an elderly person, and a relative, and CPR techniques consisting of chest compression plus mouth-to-mouth ventilation (CC plus MMV) versus chest compression only (CC only). A total of 4223 individuals (male 50%) completed the questionnaire, including high school students, teachers, emergency medical technicians (EMTs), medical nurses, and medical students. About 70% of the subjects had experienced CPR training more than once. Only 10-30% of high school students, teachers, and health care providers reported willingness to perform CC plus MMV, especially on a stranger or trauma victim. In contrast, 70-100% of these subjects reported willingness to perform CC only, which was the same as in our previous study. The reasons for the unwillingness among laypeople to perform CC plus MMV were inadequate knowledge and/or doubt regarding whether they could perform the techniques effectively, while health care providers reported a fear contracting of a disease. Most laypeople and health care providers are unlikely to perform CC plus MMV, especially on a stranger or trauma victim, but are more likely to perform CC only, as also found in our previous study in 1998. These findings suggest that MMV training should be de-emphasised and the awareness of CC alone should be emphasised because

  5. Factors predicting outcome of cardiopulmonary resuscitation in a developing country: the Siriraj cardiopulmonary resuscitation registry.

    Science.gov (United States)

    Krittayaphong, Rungroj; Saengsung, Panisara; Chawaruechai, Tanawin; Yindeengam, Ahthit; Udompunturak, Suthipol

    2009-05-01

    Outcomes of cardiac arrest and cardiopulmonary resuscitation (CPR) are not usually evaluated or monitored extensively in developing countries. To determine the outcome of CPR and the factors predicting its outcome. Siriraj Hospital is a 2,400-bed, 17-building, university hospital. Data were analyzed from the Siriraj CPR registry which was modified from the Utstein template. Data entry consisted of demographic data, reason for cardiac arrest, rhythm causing cardiac arrest, type of ward, type of department, status of patients before the event as well as sequence of action including the use of medications and outcome of CPR. The primary outcomes were rated to return of spontaneous circulation (ROSC) and survival to discharge. Univariate and multivariable logistic regression analysis were performed. Approximately 95,000 patients were admitted to the hospital each year. There were a total of 2,747 CPR reports during the time frame from January 2003 to December 2006. Of these 57.9% were males. The average age was 53.3 +/- 25.2 years. Most cardiac arrests occurred in the medicine, surgery and pediatric wards. Basic life support (BLS) was started within 1 minute in 83.1% and advanced life support (ALS) was started within 4 minutes in 78.6%. Of 516 (18.8%) patients were terminal cases. Outcomes of CPR were as follows: 49.8% had ROSC, 21% survived at 24 hours, and 7.4% survived to discharge. From a logistic regression analysis, predicting factors for both ROSC and survival to discharge included non-terminal cases, witnessed arrest, non-cardiac, non-sepsis causes, and arrest during daytime. The rate of ROSC and survival to discharge from the Siriraj CPR registry were 49.8% and 7.4% respectively. Several factors can be used to predict the immediate outcome of CPR. The present analysis should help monitor the quality of CPR and post-resuscitation care and aid in the strategic planning to improve CPR outcomes.

  6. Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: a randomised crossover mannequin pilot study.

    Science.gov (United States)

    Semeraro, Federico; Frisoli, Antonio; Loconsole, Claudio; Bannò, Filippo; Tammaro, Gaetano; Imbriaco, Guglielmo; Marchetti, Luca; Cerchiari, Erga L

    2013-04-01

    Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. Mini-VREM system consists of a Kinect(®) (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1h pause and a second 2 min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min(-1) and compression depth between 50 and 60mm); compressions rate within 100-120 min(-1); compressions depth within 50-60mm. When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, ppeople in a simulated CA scenario, in terms of compression rate and depth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

    Science.gov (United States)

    Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

    2012-09-01

    This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p Leadership skills were not significantly associated with more simple technical skills such as chest-compression rate, depth, and ventilation rate. Prior training in team leader skills was independently associated with better leadership behavior. There is an association between team leadership skills and cardiac arrest simulation test score, preshock pause, and hands off ratio. Developing leadership

  8. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  9. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    OpenAIRE

    Lakshmi Rajeswaran; Valerie J. Ehlers

    2013-01-01

    Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR) with functional equipment and adequate resources. The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to...

  10. Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

    Science.gov (United States)

    Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

    2017-10-01

    To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

  11. Pre-hospital extra-corporeal cardiopulmonary resuscitation.

    Science.gov (United States)

    Singer, Ben; Reynolds, Joshua C; Lockey, David J; O'Brien, Ben

    2018-03-27

    Survival from out-of-hospital cardiac arrest (OHCA) has remained low despite advances in resuscitation science. Hospital-based extra-corporeal cardiopulmonary resuscitation (ECPR) is a novel use of an established technology that provides greater blood flow and oxygen delivery during cardiac arrest than closed chest compressions. Hospital-based ECPR is currently offered to selected OHCA patients in specialized centres. The interval between collapse and restoration of circulation is inversely associated with good clinical outcomes after ECPR. Pre-hospital delivery of ECPR concurrent with conventional resuscitation is one approach to shortening this interval and improving outcomes after OHCA. This article examines the background and rationale for pre-hospital ECPR; summarises the findings of a literature search for published evidence; and considers candidate selection, logistics, and complications for this complex intervention.

  12. Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled prospective study in secondary schools in Germany.

    Science.gov (United States)

    Wingen, Sabine; Schroeder, Daniel C; Ecker, Hannes; Steinhauser, Susanne; Altin, Sibel; Stock, Stephanie; Lechleuthner, Alex; Hohn, Andreas; Böttiger, Bernd W

    2018-01-02

    Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. Prospective, randomised-interventional controlled study. Four secondary schools in Germany. Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P confidence (P confidence [odds ratio (OR), 1.20; 95% confidence interval (95% CI), 1.02 to 1.41; P = 0.032]. The long-term benefit in the level of knowledge and self-confidence were significantly higher in native compared with immigrant schoolchildren: (OR, 1.79; 95% CI, 1.14 to 2.82; P = 0.011) and (OR, 1.67; 95% CI, 1.07 to 2.60; P = 0.024), respectively. Guideline compliant (90 min) theoretical and practical CPR training improves the level of knowledge and self-confidence in 14 to 18-year-old schoolchildren. Older schoolchildren are more likely to have increased self-confidence with respect to initiating CPR. Schoolchildren with an immigrant background showed a significantly lower increase in their level of knowledge and self

  13. Short lessons in basic life support improve self-assurance in performing cardiopulmonary resuscitation

    Science.gov (United States)

    Kobras, Mario; Langewand, Sascha; Murr, Christina; Neu, Christiane; Schmid, Jeannette

    2016-01-01

    BACKGROUND: There are several reasons why resuscitation measures may lead to inferior results: difficulties in team building, delayed realization of the emergency and interruption of chest compression. This study investigated the outcome of a new form of in-hospital cardiopulmonary resuscitation (CPR) training with special focus on changes in self-assurance of potential helpers when faced with emergency situations. METHODS: Following a 12-month period of CPR training, questionnaires were distributed to participants and non-participants. Those non-participants who intended to undergo the training at a later date served as control group. RESULTS: The study showed that participants experienced a significant improvement in self-assurance, compared with their remembered self-assurance before the training. Their self-assurance also was significantly greater than that of the control group of non-participants. CONCLUSION: Short lessons in CPR have an impact on the self-assurance of medical and non-medical personnel. PMID:27942341

  14. Families? Stressors and Needs at Time of Cardio-Pulmonary Resuscitation: A Jordanian Perspective

    OpenAIRE

    Masa?Deh, Rami; Saifan, Ahmad; Timmons, Stephen; Nairn, Stuart

    2013-01-01

    Background: During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hos...

  15. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century

    OpenAIRE

    Ekmektzoglou, Konstantinos A.; Johnson, Elizabeth O.; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation...

  16. Retrospective investigation of cardiopulmonary resuscitation outcome in 146 exotic animals.

    Science.gov (United States)

    Onuma, Mamoru; Kondo, Hirotaka; Ono, Sadaharu; Murakami, Akiyoshi; Harada, Tomoko; Sano, Tadashi

    2017-09-29

    The outcomes of cardiopulmonary resuscitation (CPR) were retrospectively evaluated in 146 exotic animals including 20 pet birds, 47 rabbits, 34 hamsters, 18 ferrets, 7 turtles and 20 other small mammals in cardiopulmonary arrest (CPA) at presentation or during hospitalization at an animal clinic. The rates of return of spontaneous circulation, survival after CPR and discharge were 9.3, 2.3 and 1.2%, respectively. The mean success rate of CPR in animals included in this study was lower than those previously reported in dogs and cats. This might have been because of the challenges in effective chest compression, airway management and monitoring as well as establishment of intravenous catheterization route in exotic animals.

  17. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.

    Science.gov (United States)

    Niles, Dana E; Duval-Arnould, Jordan; Skellett, Sophie; Knight, Lynda; Su, Felice; Raymond, Tia T; Sweberg, Todd; Sen, Anita I; Atkins, Dianne L; Friess, Stuart H; de Caen, Allan R; Kurosawa, Hiroshi; Sutton, Robert M; Wolfe, Heather; Berg, Robert A; Silver, Annemarie; Hunt, Elizabeth A; Nadkarni, Vinay M

    2018-03-10

    Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. Twelve pediatric hospitals across United States, Canada, and Europe. In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. None. There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and

  18. ASSESSMENT OF KNOWLEDGE & ATTITUDE OF THE PEDIATRIC RESIDENT ABOUT NEONATAL & PEDIATRIC CARDIOPULMONARY RESUSCITATION

    Directory of Open Access Journals (Sweden)

    M KADIAVAR

    2003-09-01

    Full Text Available Introduction: A high leve of skill & knowledge is required in circumstances of cardiopulmonary resucitation which represents the most urgent clinical situations. The difficulties for pediatric residents who are fronted with the most cases of pediatric & neonatal resucitation are due to different causes of cardiorespiratory arrest in camparison to adults. This study aimed to assess the knowledge & their personal attitude toward the neonatal & pediatric cardiopulmonary resuscitatin. Methods: By cross - sectional multicenter study between the pediatric residents who were studied in the teaching hospitals in Tehran (1378-90. Data were gathered among 140 residents by self-completed questionnaires which were included three parts as. demographic information assessment of their attitude by summation of score via ranking list questions and total score from assessment to their knowledge by different scenarios which were formatted in the multiple choice questions. Results: 35.7% of the residents studied in the first year of residency 35.0% in the second year and the remainder (29/3% in the third year More than 90% of them considered their knowledge about neonatal and pediatric cardiopulmonary resuscitation low & less than average. Net only 80% of the residents self - assessed their actual ability about this issue low but also declaired the insufficient education during the medical training. The total score of knowledge assessment was 14.7 + 1_0.54 from 30 without any significant relations among the residents in different hospitals or various levels of pediatric residency. (P value= 0.1 , 0.7 There was not significant correlation between the total score from their attitude & their knowledge. Conclusion: Pediatric residents as the key personnel in the management of cardiopulmonary resuscitation of the neonates and children should have enough knowledge and skills about this topic. This survey demonstrates a low level of the pediatric & neonatal

  19. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation.

    Science.gov (United States)

    Mitchell, Michael J; Stubbs, Benjamin A; Eisenberg, Mickey S

    2009-01-01

    Although socioeconomic status (SES) has been linked to multiple health outcomes, there have been few studies of the effect of SES on the provision of bystander cardiopulmonary resuscitation (CPR) during cardiac arrest events and no studies that we know of on the effect of SES on the provision of dispatcher-assisted bystander CPR. This study sought to define the relationship between SES and the provision of bystander CPR in an emergency medical system that includes dispatcher-provided CPR instructions. This study was a retrospective, cohort analysis of cardiac arrests due to cardiac causes occurring in private residences in King County, Washington, from January 1, 1999, to December 31, 2005. We used the tax-assessed value of the location of the cardiac arrest as an estimate of the SES of potential bystanders as well as multiple measures from 2000 Census data (education, employment, median household income, and race/ethnicity). We also examined the effect of patient and system characteristics that may affect the provision of bystander CPR. Logistic regression models were used to analyze the association of these factors with two outcomes: the provision of bystander CPR with and without dispatcher assistance. Forty-four percent (1,151/2,618) of cardiac arrest victims received bystander CPR. Four hundred fifty-seven people (17.5% of the entire study population, 39.7% of those who received any bystander CPR) received CPR without telephone instructions. A total of 694 people received dispatcher-assisted bystander CPR (25.6% of the entire population, 60.4% of those receiving any bystander CPR). After adjusting for demographic and care factors, we found a strong association between the tax-assessed value of the cardiac arrest location and increased odds of the provision of bystander CPR without dispatcher instructions and bystander CPR with dispatcher assistance compared with no bystander CPR. This study suggests that higher bystander SES is associated with increased rates

  20. Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?

    Science.gov (United States)

    Rössler, B; Ziegler, M; Hüpfl, M; Fleischhackl, R; Krychtiuk, K A; Schebesta, K

    2013-07-01

    Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, pflowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Time matters – Realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian Bjerre; Østergaard, Doris

    2014-01-01

    Background: The advanced life support guidelines recommend 2 min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based res...

  2. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

    Directory of Open Access Journals (Sweden)

    Bartholomay Eduardo

    2003-01-01

    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  3. An integrative review: instructional strategies to improve nurses' retention of cardiopulmonary resuscitation priorities.

    Science.gov (United States)

    Sullivan, Nancy

    2015-04-01

    Recognizing and responding to a cardiac arrest in the hospital setting is a high stress, high anxiety event for all healthcare providers. It requires the performance of several basic, but extremely important cardiopulmonary resuscitation (CPR) skills and response priorities. If not executed correctly and in a timely manner, a bad outcome may result. Poor retention of cardiopulmonary resuscitation skills and priorities is well documented in the literature. An integrative review of the evidence was conducted to answer the question, "Is there a more effective training method to improve nurses' retention of CPR priorities during an in hospital cardiac arrest as compared to traditional American Heart Association training? "This review evaluated high fidelity and low fidelity simulation training, online or computer-based training and video instruction as potential teaching strategies focusing on CPR priorities. The role of deliberate practice is discussed. The strongest evidence suggests that a teaching plan employing brief, frequent, repetitive or deliberate practice used in collaboration with low fidelity or high fidelity simulation may be a potential strategy to improve nurses' retention of CPR priorities over time.

  4. [Basic cardiopulmonary resuscitation courses for parents of newborns and infants].

    Science.gov (United States)

    Enríquez, Diego; Castro, Adriana; Rabasa, Cecilia; Capelli, Carola; Cores Ponte, Florencia; Gutiérrez, Susana; Mariani, Gonzalo; Pacchioni, Sergio; Pardo, Amorina; Pérez, Gastón; Sorgetti, Mariana; Szyld, Edgardo

    2014-04-01

    Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients' home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients' parents as well as designing and spreading learning material.

  5. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs

    Directory of Open Access Journals (Sweden)

    Wohlfart Björn

    2010-10-01

    Full Text Available Abstract Background Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005 for cardiopulmonary resuscitation (CPR. The aim of the present study was to compare manual CPR with LUCAS-CPR. Methods 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8 or LUCAS-CPR (n = 8 was started and run for 20 minutes. Professional paramedics gave manual chest compression's alternating in 2-minute periods. Ventilation, one breath for each 10 compressions, was given to all animals. Defibrillation and, if needed, adrenaline were given to obtain a return of spontaneous circulation (ROSC. Results The mean coronary perfusion pressure was significantly (p Conclusions LUCAS-CPR gave significantly higher coronary perfusion pressure and significantly fewer rib fractures than manual CPR in this porcine model.

  6. Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel.

    Science.gov (United States)

    Monsuez, Jean-Jacques; Charniot, Jean-Christophe; Veilhan, Luc Antoine; Mougué, Ferdinand; Bellin, Marie-France; Boissonnas, Alain

    2007-05-01

    Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries. A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment. Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

  7. The two-thumb technique using an elevated surface is preferable for teaching infant cardiopulmonary resuscitation.

    Science.gov (United States)

    Huynh, Trang K; Hemway, Rae Jean; Perlman, Jeffrey M

    2012-10-01

    To determine whether the two-thumb technique is superior to the two-finger technique for administering chest compressions using the floor surface and the preferred location for performing infant cardiopulmonary resuscitation (CPR) (ie, floor, table, or radiant warmer). Twenty Neonatal Resuscitation Program trained medical personnel performed CPR on a neonatal manikin utilizing the two-thumb vs two-finger technique, a compression to ventilation ratio of 30:2 for 2 minutes in random order on the floor, table, and radiant warmer. Compression depth favored the two-thumb over two-finger technique on the floor (27 ± 8 mm vs 23 ± 7), table (26 ± 7 mm vs 22 ± 7), and radiant warmer (29 ± 4 mm vs 23 ± 4) (all P CPR preferably using an elevated firm surface. Copyright © 2012 Mosby, Inc. All rights reserved.

  8. Coronary blood flow during cardiopulmonary resuscitation in swine

    International Nuclear Information System (INIS)

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

    1984-01-01

    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic [EMF] and radiomicrosphere [RMS]) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal

  9. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

    Science.gov (United States)

    Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

    2015-03-01

    To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision

  10. Family presence during cardiopulmonary resuscitation: who should decide?

    Science.gov (United States)

    Lederman, Zohar; Garasic, Mirko; Piperberg, Michelle

    2014-05-01

    Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient's best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient's point of view. Since the patient requires CPR, he is invariably unconscious and therefore incompetent. We discuss the Autonomy Principle and the Three-Tiered process for surrogate decision making, as well as the Beneficence Principle and show that these are limited in providing us with an adequate tool for decision making in this particular case. Rather, we rely on a novel principle (or, rather, a novel specification of an existing principle) and a novel integrated model for surrogate decision making. We show that this model is more satisfactory in taking the patient's true wishes under consideration and encourages a joint decision making process by all parties involved.

  11. Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review.

    Science.gov (United States)

    Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Bernard, Stephen; Mitra, Biswadev

    2015-01-01

    Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon are not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options. The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from their commencement to the 8th July 2014. We also searched Google (scholar) for grey literature. We combined MeSH terms and text words for consciousness and CPR, and included studies of all types. The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three of these patients were sedated. Four patients arrested in the out-of-hospital setting and six arrested in hospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints. CPR-induced consciousness was infrequently reported in the medical literature, and varied in management. Given the increasing use of mechanical CPR, guidelines to identify and manage consciousness during CPR are required. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

    Science.gov (United States)

    Cobo-Vázquez, Carlos; De Blas, Gemma; García-Canas, Pablo; Del Carmen Gasco-García, María

    2018-01-01

    Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

  13. Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

    Science.gov (United States)

    Fong, Y T; Anantharaman, V; Lim, S H; Leong, K F; Pokkan, G

    2001-05-01

    Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

  14. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  15. Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals

    Directory of Open Access Journals (Sweden)

    Thoren Ann-Britt

    2011-01-01

    Full Text Available Abstract Background D-CPR (Defibrillator Cardiopulmonary Resuscitation is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR. Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators. The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR. Methods Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention. Results There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P P Conclusion Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.

  16. [Study of knowledge in cardiopulmonary resuscitation and automated external defibrillation in sports instructors of public sport centers in Asturias (Spain)].

    Science.gov (United States)

    Castro Cuervo, Coral; Cuartas Álvarez, Tatiana; Castro Delgado, Rafael; Arcos González, Pedro

    2015-01-01

    A study was conducted to determine the level of knowledge about cardiopulmonary resuscitation and automated external defibrillation (AED) in sport instructors working in public sport centers in Asturias. A cross-sectional study was conducted on sports instructors in May 2014, by completing a self-administered questionnaire on cardiopulmonary resuscitation and use of AED, with 25 items and four possible answers, only one valid, divided into five categories (emergency medical system in Asturias, initial assessment, circulation,airway and use of AED). Age, gender, work experience as sports instructor, previous training courses, education and training and employment contract were studied as epidemiological variables. A total 26 questionnaires (52%) were collected in public sports centers, and 84% of total responses were correct. It should be emphasized that among the wrong answers, 42.30% did not know what was the first action in a cardiac arrest, and 36.62% did not know how to perform a complete cardiopulmonary resuscitation if the person affected had a perioral injury, with 46.15% not knowing how to respond to a cardiac arrest due to drowning. It is recommended to include the management of cardiac arrest in their workplace in the training plans and the continuing education of sports instructors, at least every two years, according to national laws and laws from Asturias, including also training on the use and management of AED. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  17. Hemodynamic–directed cardiopulmonary resuscitation during in–hospital cardiac arrest*

    OpenAIRE

    Sutton, Robert M.; Friess, Stuart H.; Maltese, Matthew R.; Naim, Maryam Y.; Bratinov, George; Weiland, Theodore R.; Garuccio, Mia; Bhalala, Utpal; Nadkarni, Vinay M.; Becker, Lance B.; Berg, Robert A.

    2014-01-01

    Cardiopulmonary resuscitation (CPR) guidelines assume that cardiac arrest victims can be treated with a uniform chest compression (CC) depth and a standardized interval administration of vasopressor drugs. This non-personalized approach does not incorporate a patient’s individualized response into ongoing resuscitative efforts. In previously reported porcine models of hypoxic and normoxic ventricular fibrillation (VF), a hemodynamic-directed resuscitation improved short-term survival compared...

  18. Prediction of survival to discharge following cardiopulmonary resuscitation using classification and regression trees.

    Science.gov (United States)

    Ebell, Mark H; Afonso, Anna M; Geocadin, Romergryko G

    2013-12-01

    To predict the likelihood that an inpatient who experiences cardiopulmonary arrest and undergoes cardiopulmonary resuscitation survives to discharge with good neurologic function or with mild deficits (Cerebral Performance Category score = 1). Classification and Regression Trees were used to develop branching algorithms that optimize the ability of a series of tests to correctly classify patients into two or more groups. Data from 2007 to 2008 (n = 38,092) were used to develop candidate Classification and Regression Trees models to predict the outcome of inpatient cardiopulmonary resuscitation episodes and data from 2009 (n = 14,435) to evaluate the accuracy of the models and judge the degree of over fitting. Both supervised and unsupervised approaches to model development were used. 366 hospitals participating in the Get With the Guidelines-Resuscitation registry. Adult inpatients experiencing an index episode of cardiopulmonary arrest and undergoing cardiopulmonary resuscitation in the hospital. The five candidate models had between 8 and 21 nodes and an area under the receiver operating characteristic curve from 0.718 to 0.766 in the derivation group and from 0.683 to 0.746 in the validation group. One of the supervised models had 14 nodes and classified 27.9% of patients as very unlikely to survive neurologically intact or with mild deficits (Tree models that predict survival to discharge with good neurologic function or with mild deficits following in-hospital cardiopulmonary arrest. Models like this can assist physicians and patients who are considering do-not-resuscitate orders.

  19. Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation Using a French-Language Compression-Ventilation Pediatric Protocol.

    Science.gov (United States)

    Peters, Michael; Stipulante, Samuel; Delfosse, Anne-Sophie; Schumacher, Katarina; Mulder, André; Lebrun, Frédéric; Donneau, Anne-Françoise; Ghuysen, Alexandre

    2017-10-01

    Out-of-hospital cardiac arrest (OHCA) in pediatrics is a devastating event associated with poor survival rates. Although telephone dispatcher-assisted cardiopulmonary resuscitation (CPR; T-CPR) instructions improve the frequency and quality of bystander CPR for OHCA in adults, this support remains undeveloped in children. Our objective was to assess the effectiveness of a pediatric T-CPR protocol in untrained and trained bystanders. Secondarily, we sought to determine the feasibility and the effectiveness of ventilation in such a protocol. Eligible adults with no CPR experience were recruited in a movie theater in Liege, as well as bachelor nursing students in Liege. All volunteers were randomly assigned either to T-CPR or to no-T-CPR using randomization. The volunteers were exposed to a pediatric manikin model cardiac arrest. On the basis of Cardiff evaluation test, data were collected to evaluate CPR performance. A total of 115 volunteers were assigned to 4 groups: untrained nonguided group (n = 27), untrained guided group (n = 32), trained nonguided group (n = 26), and trained guided group (n = 30). We found an improvement in CPR performance in the guided groups. Most volunteers (81.2%) in untrained guided group and 83.3% in the trained guided group were able to give 2 ventilations after each compressions cycle. In a pediatric manikin model of OHCA, T-CPR instructions including mouth-to-mouth ventilations and chest compressions produced a significant increase in resuscitation performance not only among previously untrained but also among trained volunteers.

  20. Experimental design for study of cardiopulmonary resuscitation in dogs.

    Science.gov (United States)

    Barsan, W G; Levy, R C

    1981-03-01

    Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. Cardiac output, arterial blood pressure, and electrocardiogram were recorded for three different methods. The methods studied were closed chest compression, closed chest compression with an automatic gas-powered chest compressor, and open chest manual cardiac massage. Cardiac output for both types of external chest compression were less than 17% of control in all cases. With open chest cardiac massage, systemic arterial blood pressures were in the 50 mm Hg to 100 mm Hg range and cardiac output of up to 70% of control was achieved. Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.

  1. Brain computed tomographic findings in post-cardiopulmonary resuscitation patients

    International Nuclear Information System (INIS)

    Ishida, Tsuguharu; Yoshinaga, Kazumasa; Horibe, Takashi; Kokubu, Kiyokazu; Kokura, Yoshihiro; Matsui, Konosuke; Inamoto, Kazuo.

    1986-01-01

    We retrospectively assessed the brain computed tomographic (CT) findings in 22 post-cardiopulmonary resuscitation (CPR) patients excluding neonatal cases. On the basis of the CT findings, the patients were divided into two groups. Eight patients (36.4 %) had bilateral abnormal lowdensity areas in the basal ganglia (Group I). The remaining 14 patients (63.6 %) had no abnormalities in that area (Group II). In Group I, the incidence of primary cardiac arrest and duration of advanced life support (ALS) was significantly different (p < 0.05) from Group II. Sex, age, duration of basic life support (BLS), time elapsed from initiation of BLS to initial CT and from initiation of ALS to initial CT was not significantly different between the two groups. Outcome was very poor in both groups and no significant difference was noted between them. We conclude that primary cardiac arrest and long duration of ALS were predictors of abnormal bilateral low-density areas in the basal ganglia in post-CPR patients. However, their appearance was not related to outcome. (author)

  2. Family presence during cardiopulmonary resuscitation: cardiac health care professionals' perspectives.

    Science.gov (United States)

    Kosowan, Sarah; Jensen, Louise

    2011-01-01

    Family presence (FP) during cardiopulmonary resuscitation (CPR) is becoming an increasing practice. Within current literature, the attitudes and beliefs towards FP of cardiac health care professionals in Canada are limited. The purpose of this project was to examine the perceptions of cardiac health care professionals (n=368) concerning FP during CPR. A survey was conducted to explore the attitudes and beliefs of cardiac health care professionals towards family presence during CPR within five Edmonton and surrounding area hospitals. The response rate was 46%, with the greatest response from nurses and physicians. Of the respondents, 44.3% believed that family should have the option to be present, and 40.9% believed that family should be allowed at the bedside during CPR. Less than half of the respondents had experience with FP during CPR. The barriers identified towards FP were lack of support for families, the experience would be too traumatic for families, families would not understand the procedures, fear of families physically interfering with procedures, FP would increase stress levels among staff, and tradition and politics excludes FP. Despite less than half the respondents supporting FP the majority endorsed development of policy and procedures to overcome barriers to FP during CPR.

  3. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  4. Association of cardiopulmonary resuscitation psychomotor skills with knowledge and self-efficacy in nursing students.

    Science.gov (United States)

    Roh, Young Sook; Issenberg, S Barry

    2014-12-01

    Effective cardiopulmonary resuscitation (CPR) skills are essential for better patient survival, but whether these skills are associated with knowledge of and self-efficacy in CPR is not well known. The purpose of this study was to assess the quality of CPR skills and identify the association of the psychomotor skills with knowledge and self-efficacy at the time of CPR skills training. A convenience sample of 124 nursing students participated in a one-group posttest-only study. The quality of CPR psychomotor skills, as assessed by structured observation using a manikin, was suboptimal. Nursing students who performed correct chest compression skills reported higher self-efficacy, but there was no association between CPR psychomotor skills and total knowledge. Rigorous skills training sessions with more objective feedback on performance and individual coaching are warranted to enable mastery learning and self-efficacy. © 2013 Wiley Publishing Asia Pty Ltd.

  5. Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

    Directory of Open Access Journals (Sweden)

    Abdolghader Assarroudi

    2017-01-01

    Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

  6. Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation.

    Science.gov (United States)

    Shultz, J J; Mianulli, M J; Gisch, T M; Coffeen, P R; Haidet, G C; Lurie, K G

    1995-02-01

    Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) utilizes a hand-held suction device with a pressure gauge that enables the operator to compress as well as actively decompress the chest. This new CPR method improves hemodynamic and ventilatory parameters when compared with standard CPR. ACD-CPR is easy to perform but may be more labor intensive. The purpose of this study was to quantify and compare the work required to perform ACD and standard CPR. Cardiopulmonary testing was performed on six basic cardiac life support- and ACD-trained St. Paul, MN fire-fighter personnel during performance of 10 min each of ACD and standard CPR on a mannequin equipped with a compression gauge. The order of CPR techniques was determined randomly with > 1 h between each study. Each CPR method was performed at 80 compressions/min (timed with a metronome), to a depth of 1.5-2 inches, and with a 50% duty cycle. Baseline cardiopulmonary measurements were similar at rest prior to performance of both CPR methods. During standard and ACD-CPR, respectively, rate-pressure product was 18.2 +/- 3.0 vs. 23.8 +/- 1.7 (x 1000, P CPR compared with standard CPR. Both methods require subanaerobic energy expenditure and can therefore be sustained for a sufficient length of time by most individuals to optimize resuscitation efforts. Due to the slightly higher work requirement, ACD-CPR may be more difficult to perform compared with standard CPR for long periods of time, particularly by individuals unaccustomed to the workload requirement of CPR, in general.

  7. Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Bradley, Carolyn; Keithline, Michelle; Petrocelli, Meghan; Scanlon, Mary; Parkosewich, Janet

    2017-03-01

    Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those ≥ 66 years old ( P = .01) and nonwhite participants were 2.7 times more likely than white participants ( P = .049) to want family presence. Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present. ©2017 American Association of Critical-Care Nurses.

  8. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study.

    Science.gov (United States)

    Zimmerman, Elise; Cohen, Naiomi; Maniaci, Vincenzo; Pena, Barbara; Lozano, Juan Manuel; Linares, Marc

    2015-11-01

    Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin. A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break. A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%). The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines. Copyright © 2015 by the American Academy of Pediatrics.

  9. Outcome after cardiopulmonary resuscitation in patients with congenital heart disease.

    Science.gov (United States)

    Van Puyvelde, Tim; Ameloot, Koen; Roggen, Mieke; Troost, Els; Gewillig, Marc; Budts, Werner; Van De Bruaene, Alexander

    2017-03-01

    Outcome after cardiopulmonary resuscitation (CPR) in patients with underlying congenital heart disease is uncertain. This study aimed at evaluating outcome after CPR in patients with underlying congenital heart disease, factors related to worse outcome after CPR and whether survivors of sudden cardiac death (SCD) have a worse outcome when compared to an age, gender and disease-matched control population. Between 1984 and 2015, all patients with congenital heart disease who received in or out-of-hospital CPR were identified from the database of congenital heart disease from the University Hospitals Leuven. Postoperative and neonatal (CPR was excluded. For each survivor of SCD, two control patients matched for gender, age and underlying heart defect were included in the study. Thirty-eight patients (66% men; median age 25 years (interquartile range 9-40); 68% out-of-hospital) were identified, of which 27 (66%) survived the event. The main cause of SCD was ventricular tachycardia or fibrillation ( n=21). Heart defect complexity (odds ratio (OR) 5.1; 95% confidence interval (CI) 1.2-21.9; P=0.027), pulmonary hypertension (OR 13.8; 95% CI 2.1-89.5; P=0.006) and time to return of spontaneous circulation (OR 1.1; 95% CI 1.0-1.1; P=0.046) were related to worse outcome. Survivors of SCD had a worse prognosis when compared to an age, gender and disease-matched control group (5-year survival 76% vs. 98%; P=0.002). The complexity of underlying heart defect, pulmonary hypertension and time to return of spontaneous circulation are related to worse outcome in the case of CPR. Survivors of SCD have a worse outcome when compared to matched controls, indicating the need for adequate implantable cardioverter defibrillator indication assessment and for stringent follow-up of patients with worsening haemodynamics.

  10. Delivery of cardiopulmonary resuscitation in the microgravity environment

    Science.gov (United States)

    Barratt, M. R.; Billica, R. D.

    1992-01-01

    The microgravity environment presents several challenges for delivering effective cardiopulmonary resuscitation (CPR). Chest compressions must be driven by muscular force rather than by the weight of the rescuer's upper torso. Airway stabilization is influenced by the neutral body posture. Rescuers will consist of crew members of varying sizes and degrees of physical deconditioning from space flight. Several methods of CPR designed to accommodate these factors were tested in the one G environment, in parabolic flight, and on a recent shuttle flight. Methods: Utilizing study participants of varying sizes, different techniques of CPR delivery were evaluated using a recording CPR manikin to assess adequacy of compressive force and frequency. Under conditions of parabolic flight, methods tested included conventional positioning of rescuer and victim, free floating 'Heimlich type' compressions, straddling the patient with active and passive restraints, and utilizing a mechanical cardiac compression assist device (CCAD). Multiple restrain systems and ventilation methods were also assessed. Results: Delivery of effective CPR was possible in all configurations tested. Reliance on muscular force alone was quickly fatiguing to the rescuer. Effectiveness of CPR was dependent on technique, adequate restraint of the rescuer and patient, and rescuer size and preference. Free floating CPR was adequate but rapidly fatiguing. The CCAD was able to provide adequate compressive force but positioning was problematic. Conclusions: Delivery of effective CPR in microgravity will be dependent on adequate resuer and patient restraint, technique, and rescuer size and preference. Free floating CPR may be employed as a stop gap method until patient restraint is available. Development of an adequate CCAD would be desirable to compensate for the effects of deconditioning.

  11. The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation.

    Science.gov (United States)

    Weng, Yi-Ming; Wu, Shih-Hao; Li, Wen-Cheng; Kuo, Chan-Wei; Chen, Shou-Yen; Chen, Jih-Chang

    2013-03-01

    This study was performed to determine the effects of sodium bicarbonate injection during prolonged cardiopulmonary resuscitation (for >15 minutes). The retrospective cohort study consisted of adult patients who presented to the emergency department (ED) with the diagnosis of cardiac arrest in 2009. Data were retrieved from the institutional database. A total of 92 patients were enrolled in the study. Patients were divided into 2 groups based on whether they were treated (group1, n = 30) or not treated (group 2, n = 62) with sodium bicarbonate. There were no significant differences in demographic characteristics between groups. The median time interval between the administration of CPR and sodium bicarbonate injection was 36.0 minutes (IQR: 30.5-41.8 minutes). The median amount of bicarbonate injection was 100.2 mEq (IQR: 66.8-104.4). Patients who received a sodium bicarbonate injection during prolonged CPR had a higher percentage of return of spontaneous circulation, but not statistical significant (ROSC, 40.0% vs. 32.3%; P = .465). Sustained ROSC was achieved by 2 (6.7%) patients in the sodium bicarbonate treatment group, with no survival to discharge. No significant differences in vital signs after ROSC were detected between the 2 groups (heart rate, P = .124; systolic blood pressure, P = .094). Sodium bicarbonate injection during prolonged CPR was not associated with ROSC after adjust for variables by regression analysis (Table 3; P = .615; odds ratio, 1.270; 95% confidence interval: 0.501-3.219) The administration of sodium bicarbonate during prolonged CPR did not significantly improve the rate of ROSC in out-of-hospital cardiac arrest. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

    Science.gov (United States)

    Fallat, Mary E

    2014-04-01

    This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.

  13. Updates in the American Heart Association guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients.

    Science.gov (United States)

    Maton, Barbara L; Smarick, Sean D

    2012-04-01

    To review the updates in the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and identify potential applications to veterinary patients. Cardiopulmonary arrest is common in veterinary emergency and critical care, and consensus guidelines are lacking. Human resuscitation guidelines are continually evolving as new clinical and experimental studies support updated recommendations. Synthesis of human, experimental animal model, and veterinary literature support the potential for updates and advancement in veterinary CPR practices. This review serves to highlight updates in the AHA guidelines for CPR and evaluate their application to small animal veterinary patients. Interventions identified will be evaluated for trans-species potential, raise questions regarding best resuscitation recommendations, and offer opportunities for further research to continue to advance veterinary CPR. The prognosis for any patient undergoing cardiopulmonary arrest remains guarded. © Veterinary Emergency and Critical Care Society 2012.

  14. Change in tidal volume during cardiopulmonary resuscitation in newborn piglets.

    Science.gov (United States)

    Li, Elliott S; Cheung, Po-Yin; O'Reilly, Megan; Schmölzer, Georg M

    2015-11-01

    The purpose of inflations during cardiopulmonary resuscitation (CPR) is to deliver an adequate tidal volume (VT) to facilitate gas exchange. However, no study has examined VT delivery during chest compression (CC) in detail to understand the effect of CC on lung aeration. The aim of the study was to examine VT changes during CC and their effect on lung aeration. Piglets were anaesthetised, instrumented and intubated with zero leak. They were then randomly assigned to CPR using either 3:1 compression:ventilation ratio (C:V) (n=6), continuous CC with asynchronous ventilations (CCaV) (90 CC/min with 30/min asynchronous ventilations) (n=6) or continuous CC superimposed with 30 s sustained inflations (CC+SI) with a CC rate of 120/min (n=5). A respiratory function monitor (NM3, Respironics, Philips, Andover, Massachusetts, USA) was used to continuously measure inspiration tidal volume (VTi) and expirational tidal volume (VTe). ANOVA with Bonferroni post-test were used to compare variables of all three groups. During the inflation in the 3:1 C:V group, the mean (SD) VTi and VTe was 23.5 (5.3) mL/kg and 19.4 (2.7) mL/kg (p=0.16), respectively. During the CC, we observed a significant VT loss in the 3:1 group with VTi and VTe being 4.1 (1.2) mL/kg and 11.1 (3.3) mL/kg (p=0.007), respectively. In the CCaV group, VTe was higher compared with VTi, but this was not significant. In the CC+SI group, a VT gain during each CC with VTi and VTe of 16.3 (3.2) mL/kg and 14 (3) mL/kg (p=0.21), respectively, was observed. VT delivery is improved using CC+SI compared with 3:1 C:V. This improvement in VT delivery may lead to better alveolar oxygen delivery and lung aeration. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Science.gov (United States)

    Burkhardt, Joshua N.; Glick, Joshua E.; Terndrup, Thomas E.

    2014-01-01

    Introduction The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (μ=117 vs. 94, p<0.001). Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (μ=86% vs. 72%, p<0.01). No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest. PMID:25035744

  16. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Directory of Open Access Journals (Sweden)

    Joshua N. Burkhardt

    2014-07-01

    Full Text Available Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results: Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (µ=117 vs. 94, p<0.001. Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (µ=86% vs. 72%, p<0.01. No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion: Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

  17. Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

    Directory of Open Access Journals (Sweden)

    Clairton Marcos Citolino Filho

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

  18. Optimal chest compression rate in cardiopulmonary resuscitation: a prospective, randomized crossover study using a manikin model.

    Science.gov (United States)

    Lee, Seong Hwa; Ryu, Ji Ho; Min, Mun Ki; Kim, Yong In; Park, Maeng Real; Yeom, Seok Ran; Han, Sang Kyoon; Park, Seong Wook

    2016-08-01

    When performing cardiopulmonary resuscitation (CPR), the 2010 American Heart Association guidelines recommend a chest compression rate of at least 100 min, whereas the 2010 European Resuscitation Council guidelines recommend a rate of between 100 and 120 min. The aim of this study was to examine the rate of chest compression that fulfilled various quality indicators, thereby determining the optimal rate of compression. Thirty-two trainee emergency medical technicians and six paramedics were enrolled in this study. All participants had been trained in basic life support. Each participant performed 2 min of continuous compressions on a skill reporter manikin, while listening to a metronome sound at rates of 100, 120, 140, and 160 beats/min, in a random order. Mean compression depth, incomplete chest recoil, and the proportion of correctly performed chest compressions during the 2 min were measured and recorded. The rate of incomplete chest recoil was lower at compression rates of 100 and 120 min compared with that at 160 min (P=0.001). The numbers of compressions that fulfilled the criteria for high-quality CPR at a rate of 120 min were significantly higher than those at 100 min (P=0.016). The number of high-quality CPR compressions was the highest at a compression rate of 120 min, and increased incomplete recoil occurred with increasing compression rate. However, further studies are needed to confirm the results.

  19. 30 : 2: A Game Designed to Promote the Cardiopulmonary Resuscitation Protocol

    Directory of Open Access Journals (Sweden)

    Imma Boada

    2016-01-01

    Full Text Available Cardiopulmonary resuscitation (CPR is a first-aid key survival technique used to stimulate breathing and keep blood flowing to the heart. Its effective administration can significantly increase the survival chances of cardiac arrest victims. We propose 30 : 2, a videogame designed to introduce the main steps of the CPR protocol. It is not intended for certification and training purpose. Driven by the 2010 European Resuscitation Council guidelines we have designed a game composed of eight mini games corresponding to the main steps of the protocol. The player acts as a helper and has to solve a different challenge. We present a detailed description of the game creation process presenting the requirements, the design decisions, and the implementation details. In addition, we present some first impressions of our testing users (25 children, five of each age from 8 to 12 years old and 12 males and 13 females. We evaluated clarity of instructions and three settings of the game: the aesthetics of scenarios, the playability, and the enjoyability of each mini game. All games were well punctuated, and there are no significantly differences between their sex. The proposed game can be a suitable tool to disseminate and promote CPR knowledge.

  20. Neonatal resuscitation: advances in training and practice

    Directory of Open Access Journals (Sweden)

    Sawyer T

    2016-12-01

    Full Text Available Taylor Sawyer, Rachel A Umoren, Megan M Gray Department of Pediatrics, Division of Neonatology, Neonatal Education and Simulation-based Training (NEST Program, University of Washington School of Medicine, Seattle, WA, USA Abstract: Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

  1. The HANDDS Program: A Systematic Approach for Addressing Disparities in the Provision of Bystander Cardiopulmonary Resuscitation

    Science.gov (United States)

    Sasson, Comilla; Haukoos, Jason S.; Eigel, Brian; Magid, David J.

    2015-01-01

    The current paradigm of bystander cardiopulmonary resuscitation (CPR) blankets a community with training. Recently, the authors have found that high-risk neighborhoods can be identified, and CPR training can be targeted in the neighborhoods in which it is most needed. This article presents a novel method and pilot implementation trial for the HANDDS (identifying High Arrest Neighborhoods to Decrease Disparities in Survival) program. The authors also seek to describe example methods in which the HANDDS program is being implemented in Denver, Colorado. The HANDDS program uses a simple three-step approach: identify, implement, and evaluate. This systematic conceptual framework uses qualitative and quantitative methods to 1) identify high-risk neighborhoods, 2) understand common barriers to learning and performing CPR in these neighborhoods, and 3) implement and evaluate a train-the-trainer CPR Anytime intervention designed to improve CPR training in these neighborhoods. The HANDDS program is a systematic approach to implementing a community-based CPR training program. Further research is currently being conducted in four large metropolitan U.S. cities to examine whether the results from the HANDDS program can be successfully replicated in other locations. PMID:25269587

  2. The Knowledge of and Attitudes Toward First Aid and Cardiopulmonary Resuscitation Among Parents.

    Science.gov (United States)

    Míguez-Navarro, Concepción; Ponce-Salas, Beatriz; Guerrero-Márquez, Gloria; Lorente-Romero, Jorge; Caballero-Grolimund, Elena; Rivas-García, Arístides; Almagro-Colorado, María Ana

    2018-03-27

    To determine the level of knowledge of first aid and cardiopulmonary resuscitation (CPR) among the parents of children who attended our Pediatric Emergency Department and to identify the factors that affect this knowledge. Descriptive, transversal study. A questionnaire was distributed anonymously among parents to collect data about their previous CPR training, knowledge and experience. A total 405 valid questionnaires were returned. The mean age of the sample was 38.08 (SD 7.1) years, and 66.9% of participants were female. The mean score of correctly answered questions was 6.76 out of 19 questions. Parents with a university education received a mean score of 7.16 versus 6.24 for those with a primary education (p = 0.022). Parents with previous training received a higher mean score (8.04 vs 6.17, respectively, p training. Knowledge of first aid among the general population is lacking. Parents with previous training in this field, those with a university-level education, and those who are healthcare providers and educational professionals received significantly higher scores. Studies based on surveys can be useful in estimating a population's knowledge base, allowing the development of community-based training activities. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. The Level of Awareness of Cardio-Pulmonary Resuscitation (CPR ...

    African Journals Online (AJOL)

    Resuscitation is one of the most evolving areas of modern medicine. For the past forty years newer techniques are developed in order to improve the outcome of resuscitation. The study is aimed at finding the level of knowledge amongst radiographers practising in Nigeria because radiographers use materials that ...

  4. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian

    2016-01-01

    AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return...... of spontaneous circulation (ROSC). METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by emergency......: Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile....

  5. Detection of a spontaneous pulse in photoplethysmograms during automated cardiopulmonary resuscitation in a porcine model

    NARCIS (Netherlands)

    Wijshoff, R.W.; Sar, T. van der; Peeters, W.H.; Bezemer, R.; Aelen, P.; Paulussen, I.W.; Ordelman, S.C.; Venema, A.; Berkom, P.F. van; Aarts, R.M.; Woerlee, P.H.; Scheffer, G.J.; Noordergraaf, G.J.

    2013-01-01

    INTRODUCTION: Reliable, non-invasive detection of return of spontaneous circulation (ROSC) with minimal interruptions to chest compressions would be valuable for high-quality cardiopulmonary resuscitation (CPR). We investigated the potential of photoplethysmography (PPG) to detect the presence of a

  6. Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia.

    NARCIS (Netherlands)

    Bergman, R.; Tjan, D.H.; Adriaanse, M.W.; Vugt, R. van; Zanten, A.R. van

    2008-01-01

    A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of

  7. extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest

    DEFF Research Database (Denmark)

    Obling, Laust; Wiberg, Sebastian; Møller, Jacob Eifer

    2017-01-01

    Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of e...

  8. Imaging the human microcirculation during cardiopulmonary resuscitation in a hypothermic victim of submersion trauma

    NARCIS (Netherlands)

    Elbers, Paul W. G.; Craenen, Antonius J.; Driessen, Antoine; Stehouwer, Marco C.; Munsterman, Luuk; Prins, Miranda; van Iterson, Mat; Bruins, Peter; Ince, Can

    2010-01-01

    The microcirculation is essential for delivery of oxygen and nutrients to tissue. However, the human microvascular response to cardiopulmonary resuscitation (CPR) is unknown. We report on the first use of sidestream dark field imaging to assess the human microcirculation during CPR with a mechanical

  9. Prevalence of systemic air-embolism after prolonged cardiopulmonary resuscitation in newborns: A pilot study.

    Science.gov (United States)

    Halbertsma, Feico J J; Mohns, Thilo; Bok, Levinus A; Niemarkt, Hendrik J; Kramer, Boris W

    2015-08-01

    Chest compressions (CC) during cardiopulmonary resuscitation (CPR) are the cornerstone of adult CPR protocols and are meant to restore circulation and improve outcome. Although adverse effects such as air-embolisms have been reported, these are rare and considered to be outweighed by beneficial effect. In newborns, however, the lung tissue is more fragile. Thus, the high intra-thoracic pressures resulting from CC may make the newborns more vulnerable for air-embolisms. We studied the postmortem prevalence of air-embolism in neonates that have received CPR. Prospective cohort analysis of newborns receiving CC during CPR. CPR was performed by trained staff according to ILCOR guidelines, in a tertiary hospital. Air-embolisms were sought after using CT/MRI and autopsy. During a 61/2 year period (2007-2014), n = 56 newborns received CC. Newborns were resuscitated following severe perinatal hypoxia, or due to complications during NICU treatment. In n = 14 (25.0%) circulation could not be restored (mean CPR duration: 32.7 ± 15.2 min). Post-mortem CT/MRI was performed in n = 9, of whom n = 8 (88.9%) had air-embolisms. Autopsy was performed in n = 9. The air-embolisms could not be retraced on autopsy except for n = 1 patient. In patients with CPR resulting in restored circulation (n = 42), no CT or MRI was performed for comparison due to radiation and/or hemodynamic instability. Cerebral ultrasound could not identify or exclude air-embolisms in this subgroup. Post-mortem CT after prolonged resuscitation showed a high prevalence of intravascular air-embolism. Autopsy was not suited to detect air-embolism. The clinical importance of air-embolisms on the lethal outcome needs further research. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Effect of material and training on guideline-compliant neonatal resuscitation in the delivery room

    OpenAIRE

    Dold, Simone Katrin

    2015-01-01

    Introduction The transition from intrauterine to extrauterine life requires a complex physiological process, nevertheless most neonates manage to go through it on their own. Only 10% need respiratory assistance. Neonatal cardiopulmonary resuscitation (CPR) including chest compressions (CC) is with < 1% a rare event in the delivery room. However medical staff needs to be proficient in neonatal CPR and in handling the different devices. Training, based on international resuscitation guidelin...

  11. Predictors of public support for family presence during cardiopulmonary resuscitation: A population based study.

    Science.gov (United States)

    Dwyer, Trudy A

    2015-06-01

    The debate on whether individuals want their family to be present during cardiopulmonary resuscitation continues to be a contentious issue, but there is little analysis of the predictors of the general public's opinion. The aim of this population based study was to identify factors that predict public support for having family present during cardiopulmonary resuscitation. Data for this cross-sectional population based study were collected via computer-assisted-telephone-interviews of people (n=1208) residing in Central Queensland, Australia. Participants supported family members being present should their child (75%), an adult relative (52%) or they themselves (51%) require cardiopulmonary resuscitation. Reasons cited for not wanting to be present were; distraction for the medical team (30.4%), too distressing (30%) or not known/not considered the option (19%). Sex and prior exposure to being present during the resuscitation of adults and children were both predictors of support (presuscitation varies according to; sex, prior exposure and if the family member who is being resuscitated is a family member, their child or the person themselves. A considerable proportion of the public have not considered nor planned for the option of being present during a cardiac arrest of an adult relative. Clinicians may find it useful to explain the experiences of other people who have been present when supporting families to make informed decisions about their involvement in emergency interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Knowledge and psychomotor skills of nursing students in North Cyprus in the area of cardiopulmonary resuscitation.

    Science.gov (United States)

    Dal, Umran; Sarpkaya, Dilek

    2013-07-01

    Objective : The aim of the study was to determine the cardiopulmonary resuscitation (CPR) knowledge and skill levels of nursing students in North Cyprus. Methods : The study design was quasi-experimental and longitudinal. A questionnaire was applied to the students before the CPR lecture. Then the students were informed about adult CPR by the researchers and all of the students practiced CPR on a Resusci-Anne manikin. One and six months after this training the same questionnaire and skills checklist of CPR were applied. Results : Eighty three third year students of nursing participated in the study. While the average CPR knowledge score of these students was 9.3 ± 2.9 out of 23 before the lecture, this average increased to 17.0 ± 1.8 one month after the CPR lecture and decreased by two points back to 14.9 ± 3.8 after six months. Skill score of the students one month after the CPR skills training was 18.4 out of 21, and that this average decreased to 13.8 after six months (p<0.05). Nursing students tend to forget theoretical and applied CPR training after couple of months. Hence there is a need for continuous CPR training and education and repeating the skills at regular intervals even after they have graduated to ensure sustainability in the CPR skills.

  13. Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moreira Daniel Martins

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

  14. Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.

    Science.gov (United States)

    Harris, Dylan; Willoughby, Hannah

    2009-11-01

    Patients' preferences for cardiopulmonary resuscitation (CPR) relate to their perception about the likelihood of success of the procedure. There is evidence that the lay public largely base their perceptions about CPR on their experience of the portrayal of CPR in the media. The medical profession has generally been critical of the portrayal of CPR on medical drama programmes although there is no recent evidence to support such views. To compare the patient characteristics, cause and success rates of cardiopulmonary resuscitation (CPR) on medical television drama with published resuscitation statistics. Observational study. 88 episodes of television medical drama were reviewed (26 episodes of Casualty, Casualty, 25 episodes of Holby City, 23 episodes of Grey's Anatomy and 14 episodes of ER) screened between July 2008 and April 2009. The patient's age and sex, medical history, presumed cause of arrest, use of CPR and immediate and long term survival rate were recorded. Immediate survival and survival to discharge following CPR. There were a total of 76 cardio-respiratory arrests and 70 resuscitation attempts in the episodes reviewed. The immediate success rate (46%) did not differ significantly from published real life figures (p=0.48). The resuscitation process appeared to follow current guidelines. Survival (or not) to discharge was rarely shown. The average age of patients was 36 years and contrary to reality there was not an age related difference in likely success of CPR in patients less than 65 compared with those 65 and over (p=0.72). The most common cause of cardiac arrest was trauma with only a minor proportion of arrests due to cardio-respiratory causes such as myocardial infarction. Whilst the immediate success rate of CPR in medical television drama does not significantly differ from reality the lack of depiction of poorer medium to long term outcomes may give a falsely high expectation to the lay public. Equally the lay public may perceive that the

  15. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Science.gov (United States)

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  16. Prolonged successful cerebro cardiopulmonary resuscitation. A case report

    International Nuclear Information System (INIS)

    Medina, Libardo A; Sanchez, Robinson; Gomez, Maria T; Cabrales, Jaime R; Echeverri, Dario

    2010-01-01

    We present the case of a 57 year old patient patient who underwent a diagnostic coronariography that showed three-vessel coronary disease. He presented cardiorespiratory arrest immediately at the end of the procedure; basic and advanced resuscitation maneuvers were started during a two hours period. During the resuscitation, primary angioplasty and stent implantation in the circumflex artery was performed. The patient recovered spontaneous circulation and was transferred to the coronary care unit. On the second day, a successful myocardial revascularization was performed and was discharged 16 days after the event without evident neurological deficit.

  17. Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement

    NARCIS (Netherlands)

    Boller, Manuel; Fletcher, Dan J; Brainard, Benjamin M; Haskins, Steve; Hopper, Kate; Nadkarni, Vinay M; Morley, Peter T; McMichael, Maureen; Nishimura, Ryohei; Robben, Joris H; Rozanski, Elizabeth; Rudloff, Elke; Rush, John; Shih, Andre; Smarick, Sean; Tello, Luis H

    2016-01-01

    OBJECTIVE: To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology. DESIGN: Consensus guidelines. SETTING: International, academia, referral

  18. [Effect of emergency care simulator combined with problem-based learning in teaching of cardiopulmonary resuscitation].

    Science.gov (United States)

    Wang, Xiao-Ping; Martin, S Mok; Li, Ya-Lan; Chen, Jian; Zhang, Ya-Ming

    2008-06-17

    To evaluate the teaching effects of emergency care simulator (ECS) combined with problem-based learning (PBL) in teaching of cardiopulmonary resuscitation (CPR). 42 medical students were randomly divided into 2 equal groups, control group receiving PBL and training of specific operation such as artificial respiration, external cardiac compression, tracheal intubation, and defibrillation, and ECS group receiving ECS training in addition. Then test was given to record the scores in artificial respiration. A questionnaire survey was conducted to collect the feedback. There were no significant differences in the scores of artificial respiration, external cardiac compression, tracheal intubation, and defibrillation between the 2 groups (all P > 0.05). There were significant differences between the Control group and the ECS group (P cooperative effort, with improved analytic skill in clinical setting and in amalgamating the theoretic learning with textbook knowledge and clinical practice were all higher in the ECS group than in the control group (all P < 0.05). More than 86% of the students considered that there was significant difference between these two groups. Using ECS combined with PBL in teaching CPR technique directly involves the medical students in "emergency practice", resolving of "all sorts of problems", enhancing emergency awareness, and emergency skill. It can improve teaching quality significantly that is in accordance with the development of modern medicine.

  19. Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation.

    Science.gov (United States)

    Matsumoto, Cal S; Kaufman, Stuart S; Girlanda, Raffaele; Little, Cheryl M; Rekhtman, Yuliya; Raofi, Vandad; Laurin, Jaqueline M; Shetty, Kirti; Fennelly, Erin M; Johnson, Lynt B; Fishbein, Thomas M

    2008-10-15

    Cardiopulmonary resuscitation (CPR) of a person destined to become an organ donor has been associated with overall poor donor quality, especially for the intestinal donor, as splanchnic vasoconstriction that is intended to preserve coronary and cerebral blood flow may result in clinically relevant intestinal ischemia. Outcomes of recipients who receive intestine grafts that have suffered CPR are unknown. We sought to analyze our clinical experience in using intestinal grafts from donors who suffered cardiopulmonary arrest and resuscitation and to evaluate the outcome of recipients of organs coming from resuscitated donors when compared with recipients of nonresuscitated donors. We retrospectively analyzed the donor and recipient charts of all of our intestinal transplants with regard to the performance of donor CPR. Sixty-seven intestinal transplants were performed in 65 patients from November 2003 to December 2007. Twelve donors (18%) were identified as having suffered cardiac arrest and subsequent CPR. Mean duration of CPR was 19.3+/-12.7 min. Terminal laboratory profiles of CPR donors and non-CPR donors were similar. Of the 12 resuscitated grafts, two were used for multivisceral, one for a modified multivisceral, seven for liver-intestine, and two for isolated intestinal transplant. There were no significant differences in outcome parameters such as operative time, blood use, ventilation days, length of stay, time to enteral independence, rejection, enteric bacteremia, and survival between the 12 resuscitated grafts and the 55 nonresuscitated grafts. A donor history of cardiac arrest should not automatically exclude the use of the intestine graft for transplantation.

  20. Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning.

    Science.gov (United States)

    Cason, Carolyn L; Kardong-Edgren, Suzan; Cazzell, Mary; Behan, Deborah; Mancini, Mary Elizabeth

    2009-01-01

    Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

  1. Latent myocardial damage after cardiopulmonary resuscitation in a teenager without prior cardiac disease

    Directory of Open Access Journals (Sweden)

    A. S. Sharykin

    2014-01-01

    Full Text Available Cardiopulmonary resuscitation is an integral part of intensive care in children and adolescents with a number of diseases, most commonly with congenital heart disease, critical cardiac arrhythmias, or severe traumas. This procedure can cause a number of complications, most of them are still completely unstudied, and many of them are associated with the underlying disease. We have a unique case report of a 14-year-old boy without any cardiac disease, who underwent extensive resuscitative measures, including closed-chest massage, tracheal intubation with mechanical ventilation, as well as a few electrical defibrillations with transient myocardial injury. 

  2. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    DEFF Research Database (Denmark)

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E

    1990-01-01

    /kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary...

  3. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    OpenAIRE

    Botelho,Renata Maria de Oliveira; Campanharo,Cássia Regina Vancini; Lopes,Maria Carolina Barbosa Teixeira; Okuno,Meiry Fernanda Pinto; Góis,Aécio Flávio Teixeira de; Batista,Ruth Ester Assayag

    2016-01-01

    ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condit...

  4. Effects of flashlight guidance on chest compression performance in cardiopulmonary resuscitation in a noisy environment

    OpenAIRE

    You, Je Sung; Chung, Sung Phil; Chang, Chul Ho; Park, Incheol; Lee, Hye Sun; Kim, SeungHo; Lee, Hahn Shick

    2012-01-01

    Background In real cardiopulmonary resuscitation (CPR), noise can arise from instructional voices and environmental sounds in places such as a battlefield and industrial and high-traffic areas. A feedback device using a flashing light was designed to overcome noise-induced stimulus saturation during CPR. This study was conducted to determine whether ?flashlight? guidance influences CPR performance in a simulated noisy setting. Materials and methods We recruited 30 senior medical students with...

  5. Acute Mallory–Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    OpenAIRE

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong

    2015-01-01

    A report of a 62-year-old female patient with severe Mallory–Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient's total blood loss was estimated to be approximately 3000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory–Weiss syndrome after CPR may occur and should be considered as a potentially serious complication aft...

  6. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    OpenAIRE

    Morais, Daniela Aparecida; Carvalho, Daclé Vilma; Correa, Allana dos Reis

    2014-01-01

    OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESUL...

  7. A simple accurate chest-compression depth gauge using magnetic coils during cardiopulmonary resuscitation.

    Science.gov (United States)

    Kandori, Akihiko; Sano, Yuko; Zhang, Yuhua; Tsuji, Toshio

    2015-12-01

    This paper describes a new method for calculating chest compression depth and a simple chest-compression gauge for validating the accuracy of the method. The chest-compression gauge has two plates incorporating two magnetic coils, a spring, and an accelerometer. The coils are located at both ends of the spring, and the accelerometer is set on the bottom plate. Waveforms obtained using the magnetic coils (hereafter, "magnetic waveforms"), which are proportional to compression-force waveforms and the acceleration waveforms were measured at the same time. The weight factor expressing the relationship between the second derivatives of the magnetic waveforms and the measured acceleration waveforms was calculated. An estimated-compression-displacement (depth) waveform was obtained by multiplying the weight factor and the magnetic waveforms. Displacements of two large springs (with similar spring constants) within a thorax and displacements of a cardiopulmonary resuscitation training manikin were measured using the gauge to validate the accuracy of the calculated waveform. A laser-displacement detection system was used to compare the real displacement waveform and the estimated waveform. Intraclass correlation coefficients (ICCs) between the real displacement using the laser system and the estimated displacement waveforms were calculated. The estimated displacement error of the compression depth was within 2 mm (compression gauge, based on a new calculation method, provides an accurate compression depth (estimation error < 2 mm).

  8. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2013-05-01

    Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources.The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts.

  9. Education in cardiopulmonary resuscitation in Russia: A systematic review of the available evidence.

    Science.gov (United States)

    Birkun, Alexei; Glotov, Maksim

    2017-01-01

    To summarise and appraise cumulative published scientific evidence relevant to cardiopulmonary resuscitation (CPR) education in Russia. We searched Medline, Scopus, Science Direct and Russian Science Citation Index databases from December 1991 to December 2016 to identify studies pertaining to the field of CPR education that were carried out by Russian researchers and/or investigated the topic of interest for Russia/Russian population. Reference lists of eligible publications, contents pages of relevant Russian journals and Google Scholar were also searched. There was no limitation based on publication language or study design. Of 7 964 unique citations identified, 22 studies were included. All studies were published from 2009 to 2016, mainly in Russian. Only three studies were reported to be randomized controlled. Non-medical individuals constituted 17% of studied populations. Most of the studies aimed to assess effects of CPR educational interventions, generally suggesting positive influence of the training conducted. The studies were highly heterogeneous as for methodological approaches, structure and duration of educational interventions, evaluation methods and criteria being used. Methodological quality was generally poor, with >40% publications not passing quality screening and only 2 studies meeting the criteria of moderate high quality. The results suggest paucity, low population coverage, high thematic and methodological heterogeneity and low quality of the studies addressing CPR education, which were carried out in the Russian Federation. There is a critical need in conducting methodologically consistent, large-scale, randomized, controlled studies evaluating and comparing efficiency of educational interventions for teaching CPR in different population categories of Russia.

  10. Assessment of nursing records on cardiopulmonary resuscitation based on the utstein model

    Directory of Open Access Journals (Sweden)

    Daiane Lopes Grisante

    2014-01-01

    Full Text Available Cross-sectional study that assessed the quality of nursing records on cardiopulmonary resuscitation. Forty-two patients’ charts were reviewed in an intensive care unit, using the Utstein protocol. There was a predominance of men (54.8%, aged from 21-70 years old (38.1%, correction of acquired heart diseases (42.7%, with more than one pre-existing device (147. As immediate cause of cardiac arrest, hypotension predominated (48.3% and as the initial rhythm, bradycardia (37.5%. Only the time of death and time of arrest were recorded in 100% of the sample. Professional training in Advanced Life Support was not recorded. The causes of arrest and initial rhythm were recorded in 69% and 76.2% of the sample. Chest compressions, patent airway obtainment and defibrillation were recorded in less than 16%. Records were considered of low quality and may cause legal sanctions to professionals and do not allow the comparison of the effectiveness of the maneuvers with other centers.

  11. Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia

    International Nuclear Information System (INIS)

    Al-Turki, Yousef A.; Al-Fraih, Yasser S.; Jalalay, Jalal B.; Al-Maghlouth, Ibrahim A.; Al-Rashoudi, Fahad H.; Al-Otaibi, Azzam F.; Al-Thnayan, Anas A.; Trabzoni, Abdulmohsin I.; Al-Shaykh, Abdulaziz S.

    2008-01-01

    Objective was to assess the knowledge and attitudes towards cardiopulmonary resuscitation (CPR) among the students of King Saud University. This study was a cross sectional survey among King Saud University students, Riyadh, Kingdom of Saudi Arabia, which took place on December 17-20, 2006. The data was collected from self-administered questionnaires prepared in Arabic. The questionnaires were distributed to all 15 colleges of the university. Out of a study sample of 2250 students, 31% did not have prior CPR information. Of those with previous knowledge, 85% feel that it is inadequate. The most common sources of information were television and movies. The 12.7% of individuals encountered a situation that required the use of CPR. However, 14% of them performed it. This was mostly due to lack of knowledge (42.8%). Eighty-eight percent of students would like to learn how to perform CPR. Out of all King Saud University students, 45% believe that CPR training should be a graduation requirement. It was found that overall attitude towards CPR was positive. However, the knowledge on the topic was insufficient. Thus, more focus should be placed on the improvement of CPR skills. In addition, more studies are needed to assess knowledge and attitudes towards CPR in the community. (author)

  12. Families’ Stressors and Needs at Time of Cardio-Pulmonary Resuscitation: A Jordanian Perspective

    Science.gov (United States)

    Masa’Deh, Rami; Saifan, Ahmad; Timmons, Stephen; Nairn, Stuart

    2014-01-01

    Background: During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such polices yet. This study explores family members’ needs during resuscitation in adult critical care settings. Methods: This is a part of larger study. The study was conducted in six hospitals in two major Jordanian cities. A purposive sample of seven family members, who had experience of having a resuscitated relative, was recruited over a period of six months. Semi-structured interview was utilised as the main data collection method in the study. Findings: The study findings revealed three main categories: families’ need for reassurance; families’ need for proximity; and families’ need for support. The need for information about patient’s condition was the most important need. Updating family members about patient’s condition would reduce their tension and improve their acceptance for the end result of resuscitation. All interviewed family members wanted the option to stay beside their loved one at end stage of their life. Distinctively, most of family members want this option for some religious and cultural reasons such as praying and supplicating to support their loved one. Conclusions: This study emphasizes the importance of considering the cultural and religious dimensions in any family-witnessed resuscitation programs. The study recommends that family members of resuscitated patients should

  13. New cardiopulmonary resuscitation guidelines 2010: managing the newly born in delivery room.

    Science.gov (United States)

    Biban, Paolo; Filipovic-Grcic, Boris; Biarent, Dominique; Manzoni, Paolo

    2011-03-01

    Most newborns are born vigorous and do not require neonatal resuscitation. However, about 10% of newborns require some type of resuscitative assistance at birth. Although the vast majority will require just assisted lung aeration, about 1% requires major interventions such as intubation, chest compressions, or medications. Recently, new evidence has prompted modifications in the international cardiopulmonary resuscitation (CPR) guidelines for both neonatal, paediatric and adult patients. Perinatal and neonatal health care providers must be aware of these changes in order to provide the most appropriate and evidence-based emergency interventions for newborns in the delivery room. The aim of this article is to provide an overview of the main recommended changes in neonatal resuscitation at birth, according to the publication of the international Liaison Committee on Resuscitation (ILCOR) in the CoSTR document (based on evidence of sciences) and the new 2010 guidelines released by the European Resuscitation Council (ERC), the American Heart Association (AHA), and the American Academy of Pediatrics (AAP). Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Science.gov (United States)

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  15. Evaluation of a cardiopulmonary resuscitation curriculum in a low resource environment.

    Science.gov (United States)

    Chang, Mary P; Lyon, Camila B; Janiszewski, David; Aksamit, Deborah; Kateh, Francis; Sampson, John

    2015-11-07

    To evaluate whether a 2-day International Liaison Committee on Resuscitation (ILCOR) Universal Algorithm-based curriculum taught in a tertiary care hospital in Liberia increases local health care provider knowledge and skill comfort level. A combined basic and advanced cardiopulmonary resuscitation (CPR) curriculum was developed for low-resource settings that included lectures and low-fidelity manikin-based simulations. In March 2014, the curriculum was taught to healthcare providers in a tertiary care hospital in Liberia. In a quality assurance review, participants were evaluated for knowledge and comfort levels with resuscitation before and after the workshop. They were also videotaped during simulation sessions and evaluated on standardized performance metrics. Fifty-two hospital staff completed both pre-and post-curriculum surveys. The median score was 45% pre-curriculum and 82% post-curriculum (pprovider comfort level score was 4 of 5 pre-curriculum and 5 of 5 post-curriculum (presource setting.

  16. Resuscitation Training at Rwanda Military Hospital

    African Journals Online (AJOL)

    Learning the C-A-Bs: Resuscitation Training at Rwanda Military Hospital. Kathryn Norgang1, Auni Idi Muhire1, Sarah Howrath1. 1Rwanda Military Hospital, Rwanda. Background. There is a lack of trained staff to respond to critically ill patients and cardiac and respiratory arrests in a health facility in Rwanda. This lack of ...

  17. CT findings of the brain post cardiopulmonary resuscitation

    International Nuclear Information System (INIS)

    Imanishi, Masami; Miyamoto, Seiji; Sakaki, Toshisuke; Fukuzumi, Akio; Iwasaki, Satoru; Tabuse, Hisayuki

    1999-01-01

    The subjects were 88 cases of non-traumatic CPA excluding those with primary brain disease. The subjects were divided into 4 groups according to the duration of cardiac arrest: Group A (less than 15 minutes, 2 cases), Group B (15-30 minutes, 11 cases), Group C (more than 30 minutes, 40 cases), Group D (no resuscitation after cardiac arrest, 35 cases). All cases in Group A were observed to be clear consciousness after resuscitation. Not only the functional outcome but also the survivals rates were poorer as the duration of cardiac arrest increased in Groups B and C compared to Group A. The mortality rate was 85% or higher for cardiac arrest of 15 minutes or longer. Brain edema after resuscitation was examined by head CT in the basal-ganglia and thalamus regions, and in the corticomedullary junction of the cerebrum. In the cases of short duration of cardiac arrest, the basal-ganglia and thalamus regions, and the corticomedullary junction were clearly visible on CT. On the other hand, these areas were poorly or not visible (marked brain edema) in the cases of longer duration of cardiac arrest. The borders of the basal-ganglia and thalamus regions, and the corticomedullary junction were not obscured in any of the cases in Group A. However, the borders of these regions were poorly visible or not visible more frequently as the duration of cardiac arrest increased. In particular, the corticomedullary junction was not visible more frequently after cardiac arrest of long duration. Brain edema is caused and intensified by prolongation of hypoxia, but it is also reported to be caused by external cardiac massage, which increases the intracranial pressure. This was also suggested by the more notable brain edema in the corticomedullary junction than in the basal-ganglia and thalamus regions. These findings of brain edema appeared on head CT within 4 hours after CPR. Findings suggestive of vascular occlusion were also obtained. (K.H.)

  18. Physical training improves cardiopulmonary functional capacity and ...

    African Journals Online (AJOL)

    Physical training improves cardiopulmonary functional capacity and increases cytokine IL-10 levels in individuals with Chagas disease. Wania S Lopes, Érika C Ferreira, Suelen S Silva, Fernanda Tomiotto- Pellissier, Ivete C Costa, Wander R Pavanelli, Silvana M Araújo, Mônica L Gomes ...

  19. The effects of flipped learning for bystander cardiopulmonary resuscitation on undergraduate medical students.

    Science.gov (United States)

    Nakanishi, Taizo; Goto, Tadahiro; Kobuchi, Taketsune; Kimura, Tetsuya; Hayashi, Hiroyuki; Tokuda, Yasuharu

    2017-12-22

    To compare bystander cardiopulmonary resuscitation skills retention between conventional learning and flipped learning for first-year medical students. A post-test only control group design. A total of 108 participants were randomly assigned to either the conventional learning or flipped learning. The primary outcome measures of time to the first chest compression and the number of total chest compressions during a 2-minute test period 6 month after the training were assessed with the Mann-Whitney U test. Fifty participants (92.6%) in the conventional learning group and 45 participants (83.3%) in the flipped learning group completed the study. There were no statistically significant differences 6 months after the training in the time to the first chest compression of 33.0 seconds (interquartile range, 24.0-42.0) for the conventional learning group and 31.0 seconds (interquartile range, 25.0-41.0) for the flipped learning group (U=1171.0, p=0.73) or in the number of total chest compressions of 101.5 (interquartile range, 90.8-124.0) for the conventional learning group and 104.0 (interquartile range, 91.0-121.0) for the flipped learning group (U=1083.0, p=0.75). The 95% confidence interval of the difference between means of the number of total chest compressions 6 months after the training did not exceed a clinically important difference defined a priori. There were no significant differences between the conventional learning group and the flipped learning group in our main outcomes. Flipped learning might be comparable to conventional learning, and seems a promising approach which requires fewer resources and enables student-centered learning without compromising the acquisition of CPR skills.

  20. Comparison of different doses of epinephrine on myocardial perfusion and resuscitation success during cardiopulmonary resuscitation in a pig model.

    Science.gov (United States)

    Lindner, K H; Ahnefeld, F W; Bowdler, I M

    1991-01-01

    Published results of dose-response effects of adrenergic drugs (epinephrine [E]) vary so much between studies because of differences in animal models and duration of ischemia before drug administration. In this investigation the effects of different doses of E on coronary perfusion pressure (CPP), left ventricular myocardial blood flow (MBF) and resuscitation success were compared during closed-chest cardiopulmonary resuscitation (CPR) after a 4-minute period of ventricular fibrillation in 28 pigs. MBF was measured during normal sinus rhythm using tracer microspheres. After 4 minutes of ventricular fibrillation CPR was performed with the use of a pneumatic piston compressor. After 4 minutes of mechanical measures only, the animals were randomly allocated into four groups of seven, receiving 0.015, 0.030, 0.045, and 0.090 mg/kg E intravenously respectively. MBF measurements were started 45 seconds after E administration; hemodynamic measurements after 90 seconds. Four minutes after the first administration, the same E dose was given before defibrillation. The CPP of animals given 0.015, 0.030, 0.045 and 0.090 mg/kg E were as follows: 16.3 +/- 6.1, 25.6 +/- 5.8, 33.2 +/- 8.4 and 30.4 +/- 6.3 mm Hg. The left ventricular MBF values were: 14 +/- 9, 27 +/- 11, 43 +/- 6, 46 +/- 10 mL/min/100 g. The differences between the groups receiving 0.015 and 0.045 mg/kg and between the groups receiving 0.015 mg/kg and 0.090 mg/kg were statistically significant (P less than .05). Resuscitation success was 14.3%, 42.9%, 100% and 86.7% respectively. A significant difference in resuscitation success was found only between 0.015 mg/kg and 0.045 mg/kg E.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Cardiopulmonary resuscitation, chest compression only and teamwork from the perspective of medical doctors, surgeons and anesthesiologists.

    Science.gov (United States)

    Krajina, Irena; Kvolik, Slavica; Steiner, Robert; Kovacevic, Kristina; Lovric, Ivan

    2015-03-01

    New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals. We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims. An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR. An insufficient formal education in CPR was registered for all groups

  2. Cardiopulmonary resuscitation before defibrillation in the out-of-hospital setting: a literature review.

    Science.gov (United States)

    Winship, Christian; Williams, Brett; Boyle, Malcolm J

    2012-10-01

    Many studies over the past decade have investigated delaying initial defibrillation to perform cardiopulmonary resuscitation (CPR), as it has been associated with increased rates of restoration of spontaneous circulation and/or survival. Since 2006, a number of studies have investigated these procedures. The objective of this study was to undertake a literature review examining the commencement of CPR before defibrillation in the out-of-hospital setting. A literature review was undertaken using the electronic medical databases Ovid Medline, EMBASE, CINHAL Plus, Cochrane Systematic Review and Meditext, from their commencement to the end of June 2011. Keywords used in the search included: CPR, defibrillation, ventricular fibrillation, VF, EMS, EMT, paramedic, emergency medical service, emergency medical technician, prehospital, out-of-hospital and ambulance. References of relevant articles were also reviewed. Of the 3079 articles located, 10 met the inclusion criteria. The results of these studies showed conflicting results. All retrospective studies (n=6) indicated a benefit in performing pre-shock CPR on patients with ventricular fibrillation for durations between 90 and 180 s. Conversely, all randomised controlled trials demonstrated no benefit from providing CPR before defibrillation compared with immediate defibrillation for return of spontaneous circulation, neurological outcome and/or survival to hospital discharge. However, none of the studies reported evidence that CPR before defibrillation is harmful. Conflicting evidence remains regarding the benefit of CPR before defibrillation. The establishment of a consistent timeframe of chest compressions before defibrillation in the out-of-hospital setting will provide uniformity in standards in clinical practice and education and training.

  3. Public Knowledge and Attitudes towards Bystander Cardiopulmonary Resuscitation in China

    Directory of Open Access Journals (Sweden)

    Meng Chen

    2017-01-01

    Full Text Available The rate of bystander CPR is much lower in China than in developed countries. This survey was implemented to assess the current status of layperson CPR training, to analyze the willingness of bystanders to perform CPR, and to identify barriers to improving bystander CPR rates. The questionnaire included individual information, current status of bystander CPR training, and individual’s willingness and attitude towards performing CPR. There were 25.6% laypersons who took CPR training. The majority (98.6% of laypersons would perform CPR on their family members, but fewer laypersons (76.3% were willing to perform CPR on strangers. Most respondents (53.2% were worried about legal issues. If laws were implemented to protect bystanders who give aid, the number of laypersons who were not willing to perform CPR on strangers dropped from 23.7% to 2.4%. An increasing number of people in China know CPR compared with the situation in the past. CPR training in China is much less common than in many developed countries. The barriers are that laypersons are not well-trained and they fear being prosecuted for unsuccessful CPR. More accredited CPR training courses are needed in China. The laws should be passed to protect bystanders who provide assistance.

  4. The use of mice and rats as animal models for cardiopulmonary resuscitation research.

    Science.gov (United States)

    Papadimitriou, D; Xanthos, T; Dontas, I; Lelovas, P; Perrea, D

    2008-07-01

    Cardiopulmonary resuscitation (CPR) after the induction of cardiac arrest (CA) has been studied in mice and rats. The anatomical and physiological parameters of the cardiopulmonary system of these two species have been defined during experimental studies and are comparable with those of humans. Moreover, these animal models are more ethical to establish and are easier to manipulate, when compared with larger experimental animals. Accordingly, the effects of successful CPR on the function of vital organs, such as the brain, have been investigated because damage to these vital organs is of concern in CA survivors. Furthermore, the efficacy of several drugs, such as adrenaline (epinephrine), vasopressin and nitroglycerin, has been evaluated for use in CA in these small animal models. The purpose of these studies is not only to increase the rate of survival of CA victims, but also to improve their quality of life by reducing damage to their vital organs after CA and during CPR.

  5. A Novel Use of a Metronome in Dispatcher-assisted Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Ateyyah, Khalid A; Cady, Charles E; Poltrock, James T; Pirrallo, Ronald G

    2015-01-01

    Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.

  6. Are the current guideline recommendations for neonatal cardiopulmonary resuscitation safe and effective?

    Science.gov (United States)

    Rottenberg, Eric M

    2016-08-01

    A recently published review of approaches to optimize chest compressions in the resuscitation of asphyxiated newborns discussed the current recommendations and explored potential determinants of effective neonatal cardiopulmonary resuscitation (CPR). However, not all potential determinants of effective neonatal CPR were explored. Chest compression shallower than the current guideline recommendation of approximately 33% of the anterior-posterior (AP) chest diameter may be safer and more effective. From a physiological standpoint, high-velocity brief duration shallower compression may be more effective than current recommendations. The application of a 1- or 2-finger method of high-impulse CPR, which would depend on the size of the subject, may be more effective than using a 2-thumb (TT) encircling hands method of CPR. Adrenaline should not be used in the treatment of asphyxiated neonates and when necessary titrated vasopressin should be used. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. [Public access defibrillation: successful cardiopulmonary resuscitation due to automatic external defibrillator at traffic accident].

    Science.gov (United States)

    Wanke, S; Reuter, H; Pfister, R; Michels, G

    2014-03-01

    A 65-year-old man collapsed after he stepped out of his car after a traffic accident. Fortunately, two police officers on a routine patrol in the area were quickly on the scene and started cardiopulmonary resuscitation. A passerby noticed that the patient was in distress and that an automatic defibrillator was nearby. He attached the electrodes of the defibrillator to the chest of the patient in accordance with instructions on the defibrillator and terminated the ventricular fibrillation (200 joule, biphasic). Emergency cardiac catheterization revealed a subtotal stenosis proximally in the right coronary artery, which was successfully treated with a stent. Based on the ideal basic life support, the immediate care by emergency mobile system and coronary angioplasty with successful revascularisation the patient could be released without any neurological deficit. This case illustrates that laypersons can use automatic external defibrillator in case of cardiac resuscitation sufficiently and quickly. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Nurses' reactions to participation in cardiopulmonary resuscitation on the nursing unit.

    Science.gov (United States)

    Pups, G M; Weyker, J D; Rodgers, B L

    1997-02-01

    A wide range of emotions are associated with cardiopulmonary resuscitation (CPR) attempts. Articles documenting nurses' reactions to CPR situations are scarce in the nursing literature. This study contains nurses' own descriptions of feelings experienced during and after CPR attempts and the nurses' suggestions for what could make the experience easier, what makes it more difficult, and what interventions the nurses use to reconcile their emotions. The participants were 29 registered nurses employed at an urban Midwestern hospital who completed an open-ended questionnaire that elicited descriptions of CPR events. The data were analyzed using a process of thematic analysis.

  9. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement.

    Science.gov (United States)

    Moons, Philip; Norekvål, Tone M

    2008-01-01

    Empirical evidence suggests that family presence during cardiopulmonary resuscitation (CPR) has beneficial effects. Although many American professional organizations have endorsed the idea of family presence, there is less formal support in Europe. In addition, the attitude of nurses from Anglo-Saxon countries, such as United Kingdom and Ireland, is more positive toward family presence than the attitude of nurses of mainland Europe. In order to support existing guidelines and to stimulate health care organizations to develop a formal policy with respect to family witnessed CPR, 3 important European nursing organizations have recently developed a joint position statement.

  10. Acute Mallory–Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Directory of Open Access Journals (Sweden)

    Dae Hee Kim

    2015-10-01

    Full Text Available A report of a 62-year-old female patient with severe Mallory–Weiss syndrome after successful cardiopulmonary resuscitation (CPR by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient's total blood loss was estimated to be approximately 3000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory–Weiss syndrome after CPR may occur and should be considered as a potentially serious complication after CPR.

  11. Modelling ventricular fibrillation coarseness during cardiopulmonary resuscitation by mixed effects stochastic differential equations.

    Science.gov (United States)

    Gundersen, Kenneth; Kvaløy, Jan Terje; Eftestøl, Trygve; Kramer-Johansen, Jo

    2015-10-15

    For patients undergoing cardiopulmonary resuscitation (CPR) and being in a shockable rhythm, the coarseness of the electrocardiogram (ECG) signal is an indicator of the state of the patient. In the current work, we show how mixed effects stochastic differential equations (SDE) models, commonly used in pharmacokinetic and pharmacodynamic modelling, can be used to model the relationship between CPR quality measurements and ECG coarseness. This is a novel application of mixed effects SDE models to a setting quite different from previous applications of such models and where using such models nicely solves many of the challenges involved in analysing the available data. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Study of Survival Rate After Cardiopulmonary Resuscitation (CPR) in Hospitals of Kermanshah in 2013

    Science.gov (United States)

    Goodarzi, Afshin; Jalali, Amir; Almasi, Afshin; Naderipour, Arsalan; Kalhori, Reza Pourmirza; Khodadadi, Amineh

    2015-01-01

    Background: After CPR, the follow-up of survival rate and caused complications are the most important practices of the medical group. This study was performed aimed at determining the follow-up results after CPR in patients of university hospitals in Kermanshah in 2014. Methods: In this prospective study, 320 samples were examined. A purposive sampling method was used, and data was collected using a researcher-made information form with content and face validity and reliability of r= 0.79. Data was analyzed with STATA9 software and statistical tests, including calculation of the success rate, relative risk (RR), chi-square and Fisher at significance level of P < 0.05. Results: The initial success rate of cardiopulmonary resuscitation was equal to 15.3%, while the ultimate success rate (discharged alive from the hospital) was as 10.6%. The six-month success rate after resuscitation was 8.78% than those who were discharged alive. There were no significant statistical differences between different age groups regarding the initial success rate of resuscitation (P = 0.14), and the initial resuscitation success rate was higher in patients in morning shift (P = 0.02). Conclusion: By the results of study, it is recommended to increase the medical - nursing knowledge and techniques for personnel in the evening and night shifts. Also, an appropriate dissemination of health care staff in working shifts should be done to increase the success rate of CPR procedure. PMID:25560341

  13. Cardio-pulmonary resuscitation challenges in selected Botswana ...

    African Journals Online (AJOL)

    2013-05-07

    May 7, 2013 ... Lack of in-service CPR training. (simulation, computer assisted learning). Supplies and equipment. Annual mandatory CPR certification. Inadequate space to perform CPR. Botswana's Nursing and Midwifery. Council. Non-existing CPR policies and guidelines Lack of debriefing. CPR, cardio-pulmonary ...

  14. Gender aspects in cardiopulmonary resuscitation by schoolchildren: A systematic review.

    Science.gov (United States)

    Finke, Simon-Richard; Schroeder, Daniel C; Ecker, Hannes; Wingen, Sabine; Hinkelbein, Jochen; Wetsch, Wolfgang A; Köhler, Daniela; Böttiger, Bernd W

    2018-04-01

    Bystander CPR-rates are embarrassingly low in some European countries. To increase bystander CPR-rates, many different approaches are used; one of them is training of schoolchildren in CPR. Multiple authors investigated practical and theoretical CPR performance and demonstrated gender differences related to schoolchildren CPR. The objective was to elaborate gender aspects in practical and theoretical CPR-performance from the current literature to better address female and male students. A systematic search in PubMed-database with different search terms was performed for controlled and uncontrolled prospective investigations. Altogether, n = 2360 articles were identified and checked for aptitude. From n = 97 appropriated articles, n = 24 met the inclusion criteria and were finally included for full review and incorporated in the manuscript. Female students demonstrated higher motivation to attend CPR-training (p multiplier effect (p multiplier and need to be individually addressed in intensified practical training. Male students achieve a more sufficient chest compression depth and -fraction and could benefit from individual motivation. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR)

    Science.gov (United States)

    Hilberman, M; Kutner, J; Parsons, D; Murphy, D J

    1997-12-01

    Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated.

  16. Inviting family to be present during cardiopulmonary resuscitation: Impact of education.

    Science.gov (United States)

    Dwyer, Trudy; Friel, Deborah

    2016-01-01

    Encouraging and permitting family members to stay together during cardiopulmonary resuscitation benefits the patient, family and staff. Health care professionals (HCP) attitudes and experiences are documented as barriers to initiating family presence during cardiopulmonary resuscitation (FPDR). The aim of this pilot study was to explore the influence of education on changing HCPs attitudes and intent to provide families with the option to be present at the next cardiac arrest. A purposive sample of 29 HCP from an acute care hospital participated in this quasi-experimental study. 18 of the original 29 HCP completed both the education package and the post-test questionnaire. The majority of participants in this study had previous experience with FPDR (62%) and supported FPDR (69%). While participants had slightly more positive attitudes towards FPDR post education, this change was not significant (p = 0.79). Similarly, participation in education did not change participants concerns about safety issues or increase participant's intention to invite a family member to be present at the next cardiac arrest. The majority of participants strongly supported the development of a dedicated family support person. Education has limited impact on change participant's attitudes or intentions to invite family to be present at the next cardiac arrest. Copyright © 2015. Published by Elsevier Ltd.

  17. Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study.

    Science.gov (United States)

    Song, Y; Oh, J; Chee, Y; Cho, Y; Lee, S; Lim, T H

    2015-11-01

    Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30° left lateral tilt and 30° semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99-100 [96-117]) compressions.min(-1) with and 115 (95-128 [77-164]) compressions.min(-1) without feedback (p = 0.05), and the proportion of compressions of correct depth was 55 (0-96 [0-100])% with and 1 (0-30 [0-100])% without feedback (p = 0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0-87 [0-100])% with and 1 (0-26 [0-100])% without feedback (p = 0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  18. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery.

    Science.gov (United States)

    Erek, Ersin; Aydın, Selim; Suzan, Dilek; Yıldız, Okan; Altın, Fırat; Kırat, Barış; Demir, Ibrahim Halil; Ödemiş, Ender

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is used to provide cardiorespiratory support during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation; ECPR) unresponsive to conventional methods. In this study, the results of ECPR in a cardiac arrest setting after cardiac surgery in children were analyzed. In this retrospective cohort study, between November 2010 and June 2014, 613 congenital heart operations were performed by the same surgical team. Medical records of all the patients who experienced cardiac arrest and ECPR in an early postoperative period (n=25; 4%) were analyzed. Their ages were between 2 days and 4.5 years (median: 3 months). Sixteen patients had palliative procedures. In 88% of the patients, cardiac arrest episodes occurred in the first 24 h after operation. Mechanical support was provided by cardiopulmonary bypass only (n=10) or by ECMO (n=15) during CPR. The CPR duration until commencing mechanical support was 40 min in 12 patients. Eleven patients (44%) were weaned successfully from ECMO and survived more than 7 days. Five of them (20%) could be discharged. The CPR duration before ECMO (p=0.01) and biventricular physiology (p=0.022) was the key factor affecting survival. The follow-up duration was a mean of 15±11.9 months. While four patients were observed to have normal neuromotor development, one patient died of cerebral bleeding 6 months after discharge. Postoperative cardiac arrest usually occurs in the first 24 h after operation. ECPR provides a second chance for survival in children who have had cardiac arrest. Shortening the duration of CPR before ECMO might increase survival rates.

  19. Use of intraosseous blood to assess blood chemistries and hemoglobin during cardiopulmonary resuscitation with drug infusions.

    Science.gov (United States)

    Johnson, L; Kissoon, N; Fiallos, M; Abdelmoneim, T; Murphy, S

    1999-06-01

    To compare intraosseous with central venous blood samples for biochemical analyses and hemoglobin levels during cardiopulmonary resuscitation (CPR) and during cardiopulmonary resuscitation with infusion of sodium bicarbonate, epinephrine, and saline boluses through the intraosseous site. Prospective, complete repeated measures study. An animal laboratory at a university medical center. Thirty-two piglets (mean weight, 30 [range, 24-35] kg). Animals were anesthetized, instrumented, and subjected to hypoxic cardiac arrest. An intraosseous cannula was inserted into the tibia, and animals were randomly assigned to one of five groups: heparinized saline (n = 6), epinephrine infusions only (n = 6), saline infusions only (n = 6), sodium bicarbonate infusions only (n = 8), and epinephrine, saline, and sodium bicarbonate infusions through the same site (n = 6). CPR (chest compressions and mechanical ventilation) was performed in all groups. Simultaneous blood samples were taken from the central venous and intraosseous sites before arrest and after 5 and 30 mins of CPR. There were no differences (p CPR with infusions through the intraosseous cannula. At 30 mins, differences were apparent in magnesium, potassium, and sodium values between groups when the intraosseous cannula was used for infusions as well as sampling. Intraosseous potassium, glucose, and magnesium values were lower and sodium values were higher than central venous blood levels. No differences were seen at all sampling intervals if small-volume heparinized saline was given through the intraosseous site. Hemoglobin values were lower in the intraosseous group after 30 mins of CPR and infusions through the intraosseous site. After 30 mins of CPR, all hemoglobin values from the intraosseous site were CPR and infusions through the intraosseous site. Laboratory values may be erroneous when intraosseous blood is used during periods of resuscitation of >5 mins if drugs and fluid boluses have also been infused through

  20. Are YouTube videos accurate and reliable on basic life support and cardiopulmonary resuscitation?

    Science.gov (United States)

    Yaylaci, Serpil; Serinken, Mustafa; Eken, Cenker; Karcioglu, Ozgur; Yilmaz, Atakan; Elicabuk, Hayri; Dal, Onur

    2014-10-01

    The objective of this study is to investigate reliability and accuracy of the information on YouTube videos related to CPR and BLS in accord with 2010 CPR guidelines. YouTube was queried using four search terms 'CPR', 'cardiopulmonary resuscitation', 'BLS' and 'basic life support' between 2011 and 2013. Sources that uploaded the videos, the record time, the number of viewers in the study period, inclusion of human or manikins were recorded. The videos were rated if they displayed the correct order of resuscitative efforts in full accord with 2010 CPR guidelines or not. Two hundred and nine videos meeting the inclusion criteria after the search in YouTube with four search terms ('CPR', 'cardiopulmonary resuscitation', 'BLS' and 'basic life support') comprised the study sample subjected to the analysis. Median score of the videos is 5 (IQR: 3.5-6). Only 11.5% (n = 24) of the videos were found to be compatible with 2010 CPR guidelines with regard to sequence of interventions. Videos uploaded by 'Guideline bodies' had significantly higher rates of download when compared with the videos uploaded by other sources. Sources of the videos and date of upload (year) were not shown to have any significant effect on the scores received (P = 0.615 and 0.513, respectively). The videos' number of downloads did not differ according to the videos compatible with the guidelines (P = 0.832). The videos downloaded more than 10,000 times had a higher score than the others (P = 0.001). The majority of You-Tube video clips purporting to be about CPR are not relevant educational material. Of those that are focused on teaching CPR, only a small minority optimally meet the 2010 Resucitation Guidelines. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  1. Hypothermia and postconditioning after cardiopulmonary resuscitation reduce cardiac dysfunction by modulating inflammation, apoptosis and remodeling.

    Directory of Open Access Journals (Sweden)

    Patrick Meybohm

    Full Text Available BACKGROUND: Mild therapeutic hypothermia following cardiac arrest is neuroprotective, but its effect on myocardial dysfunction that is a critical issue following resuscitation is not clear. This study sought to examine whether hypothermia and the combination of hypothermia and pharmacological postconditioning are cardioprotective in a model of cardiopulmonary resuscitation following acute myocardial ischemia. METHODOLOGY/PRINCIPAL FINDINGS: Thirty pigs (28-34 kg were subjected to cardiac arrest following left anterior descending coronary artery ischemia. After 7 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started according to the current AHA guidelines. After successful return of spontaneous circulation (n = 21, coronary perfusion was reestablished after 60 minutes of occlusion, and animals were randomized to either normothermia at 38 degrees C, hypothermia at 33 degrees C or hypothermia at 33 degrees C combined with sevoflurane (each group n = 7 for 24 hours. The effects on cardiac damage especially on inflammation, apoptosis, and remodeling were studied using cellular and molecular approaches. Five animals were sham operated. Animals treated with hypothermia had lower troponin T levels (p<0.01, reduced infarct size (34+/-7 versus 57+/-12%; p<0.05 and improved left ventricular function compared to normothermia (p<0.05. Hypothermia was associated with a reduction in: (i immune cell infiltration, (ii apoptosis, (iii IL-1beta and IL-6 mRNA up-regulation, and (iv IL-1beta protein expression (p<0.05. Moreover, decreased matrix metalloproteinase-9 activity was detected in the ischemic myocardium after treatment with mild hypothermia. Sevoflurane conferred additional protective effects although statistic significance was not reached. CONCLUSIONS/SIGNIFICANCE: Hypothermia reduced myocardial damage and dysfunction after cardiopulmonary resuscitation possible via a reduced rate of apoptosis

  2. Impact of rescue-thrombolysis during cardiopulmonary resuscitation in patients with pulmonary embolism.

    Directory of Open Access Journals (Sweden)

    Fikret Er

    Full Text Available BACKGROUND: Cardiac arrest in patients with pulmonary embolism (PE is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63 or highly suspected (n = 41 PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5% a return of spontaneous circulation (ROSC could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.6+/-1.2 min versus 24.6+/-0.8 min; p<0.001. 19 patients (47.5% out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.0+/-1.3 vs. 22.5+/-0.9 min; p<0.001. CONCLUSION: Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.

  3. Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

    Science.gov (United States)

    Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

    2016-05-01

    Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.

    Science.gov (United States)

    McMeekin, Dawn E; Hickman, Ronald L; Douglas, Sara L; Kelley, Carol G

    2017-03-01

    Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. Postcode stress and PTSD symptom severity were weakly associated ( r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession. ©2017 American Association of Critical-Care Nurses.

  5. Interruption of cardiopulmonary resuscitation with the use of the automated external defibrillator in out-of-hospital cardiac arrest

    NARCIS (Netherlands)

    van Alem, Anouk P.; Sanou, Björn T.; Koster, Rudolph W.

    2003-01-01

    Study objective: The protocol for the use of the automated external defibrillator calls for a period of "hands-off" time, during which no cardiopulmonary resuscitation (CPR) can be performed. We assessed the actual interruption time of CPR during the use of the automated external defibrillator in

  6. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  7. A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams.

    Science.gov (United States)

    Eikeland Husebø, Sissel I; Bjørshol, Conrad A; Rystedt, Hans; Friberg, Febe; Søreide, Eldar

    2012-04-02

    Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR) in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio.We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.

  8. Cardiopulmonary Arrest and Resuscitation in Severe Sepsis and Septic Shock: A Research Model.

    Science.gov (United States)

    Chalkias, Athanasios; Spyropoulos, Vaios; Koutsovasilis, Anastasios; Papalois, Apostolos; Kouskouni, Evaggelia; Xanthos, Theodoros

    2015-03-01

    Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.

  9. Prognostic factors of the results of cardiopulmonary resuscitation in a cardiology hospital

    Directory of Open Access Journals (Sweden)

    Timerman Ari

    2001-01-01

    Full Text Available OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4% died immediately, and 164 patients (30.6% survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more. The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.

  10. A randomised controlled trial of student nurse performance of cardiopulmonary resuscitation in a simulated family-witnessed resuscitation scenario.

    Science.gov (United States)

    Kenny, Gerard; Bray, Isabelle; Pontin, David; Jefferies, Rachel; Albarran, John

    2017-05-01

    This randomized controlled trial, conducted in a UK University nursing department, compared student nurses' performance during a simulated cardiac arrest. Eighteen teams of four students were randomly assigned to one of three scenarios: 1) no family witness; 2) a "quiet" family witness; and 3) a family witness displaying overt anxiety and distress. Each group was assessed by observers for a range of performance outcomes (e.g. calling for help, timing to starting cardiopulmonary resuscitation), and simulation manikin data on the depth and timing of three cycles of compressions. Groups without a distressed family member present performed better in the early part of the basic life support algorithm. Approximately a third of compressions assessed were of appropriate pressure. Groups with a distressed family member present were more likely to perform compressions with low pressure. Groups with no family member present were more likely to perform compressions with too much pressure. Timing of compressions was better when there was no family member present. Family presence appears to have an effect on subjectively and objectively measured performance. Further study is required to see how these findings translate into the registered nurse population, and how experience and education modify the impact of family member presence. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Is peer tutoring beneficial in the context of school resuscitation training?

    Science.gov (United States)

    Lester, C; Donnelly, P; Weston, C

    1997-09-01

    First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P < 0.01). Girls had higher scores in the multiple choice paper (P < 0.025) and in the skills assessment (P < 0.01). Those pupils who reported some prior knowledge of resuscitation techniques performed better during skill assessment than novice trainees (P < 0.025).

  12. Relationship between chest compression depth and novice rescuer body weight during cardiopulmonary resuscitation.

    Science.gov (United States)

    Oh, Je Hyeok; Kim, Chan Woong

    2016-12-01

    This study determined if rescuer body weight is a major determinant of chest compression depth (CCD) among novice rescuers by analyzing the results of cardiopulmonary resuscitation (CPR) skill tests among medical students and determined the body weight threshold for those unable to achieve adequate CCD. Retrospective analysis of CPR test results was performed. A total of 107 medical students completed the tests, which included 5 cycles of CPR. Data were collected using a ResusciAnne SkillReporter. Anthropometric data including participant body weight, body mass index, and height were also collected. The relationships between CCD and anthropometric data were evaluated by Pearson correlation coefficient. In addition, univariate linear regression analysis was used to assess the association between body weight and CCD. The highest positive correlation was found between CCD and body weight (r = 0.636, P compression should preferentially be performed by rescuers of healthy weight or overweight. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Pediatric Extracorporeal Cardiopulmonary Resuscitation Patient With Traumatic Subarachnoid Hemorrhage and Takotsubo Syndrome.

    Science.gov (United States)

    Pearson, Thomas E; Frizzola, Meg A; Priest, Marc A; Rochman, Monica F; Froehlich, Curtis D

    Takotsubo syndrome is rare in pediatric patients but must be considered in patients with subarachnoid hemorrhage with pulmonary edema and cardiomyopathy. A systematic, collaborative approach is needed to facilitate emergent transfer of patients where extracorporeal cardiopulmonary resuscitation (e-CPR) is used as a lifesaving measure. Extracorporeal membrane oxygenation (ECMO) use in transport requires preplanning, role delineation, resources, and research efforts to be successful. We present an unusual transport case of successful e-CPR/ECMO treatment of Takotsubo syndrome in a 12-year-old boy with an isolated traumatic intracranial injury, cardiomyopathy with pulmonary edema, and multiple cardiac arrests. Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  14. Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation.

    Science.gov (United States)

    Halvorsen, Peter; Sharma, Hari Shanker; Basu, Samar; Wiklund, Lars

    2015-03-01

    Our aim was to investigate cerebral and cardiac tissue injury subsequent to use of vasopressin and adrenaline in combination compared with vasopressin alone during cardiopulmonary resuscitation (CPR). In a randomized, prospective, laboratory animal study 28 anesthetized piglets were subject to a 12-min untreated cardiac arrest and subsequent CPR. After 1 min of CPR, 10 of the piglets received 0.4 U/kg of arg(8)-vasopressin (V group), and 10 piglets received 0.4 U/kg of arg(8)-vasopressin, 1 min later followed by 20 µg/kg body weight of adrenaline, and another 1 min later continuous administration (10 µg/kg/min) of adrenaline (VA group). After 8 min of CPR, the piglets were defibrillated and monitored for another 3 h. Then they were killed and the brain immediately removed pending histological analysis. During CPR, the VA group had higher mean blood pressure and cerebral cortical blood flow (CCBF) but similar coronary perfusion pressure. After restoration of spontaneous circulation there was no difference in the pressure variables, but CCBF tended to be (36% ± 16%) higher in the V group. Neuronal injury and signs of a disrupted blood-brain barrier (BBB) were greater, 20% ± 4% and 21% ± 4%, respectively, in the VA group. In a background study of repeated single doses of adrenaline every third minute after 5 min arrest but otherwise the same protocol, histological measurements showed even worse neural injury and disruption of the BBB. Combined use of vasopressin and adrenaline caused greater signs of cerebral and cardiac injury than use of vasopressin alone during experimental cardiopulmonary resuscitation.

  15. An assessment of resuscitation quality in the television drama Emergency Room: guideline non-compliance and low-quality cardiopulmonary resuscitation lead to a favorable outcome?

    Science.gov (United States)

    Hinkelbein, Jochen; Spelten, Oliver; Marks, Jörg; Hellmich, Martin; Böttiger, Bernd W; Wetsch, Wolfgang A

    2014-08-01

    Two earlier studies found that outcome after cardiopulmonary resuscitation (CPR) in the television medical drama Emergency Room (ER) is not realistic. No study has yet evaluated CPR quality in ER. Retrospective analysis of CPR quality in episodes of ER. Three independent board-certified emergency physicians trained in CPR and the American Heart Association (AHA) guidelines reviewed ER episodes in two 5-year time-frames (2001-2005 and 2005-2009). Congruency with the corresponding 2000 and 2005 AHA guidelines was determined for each CPR scene. None. None. To evaluate whether CPR is in agreement with the specific algorithms of the AHA guidelines. Fisher's exact test and Mann-Whitney-U-test were used to evaluate statistical significance (P<0.05). A total of 136 on-screen cardiac arrests occurred in 174 episodes. Trauma was the leading cause of cardiac arrest (56.6%), which was witnessed in 80.1%. Return of spontaneous circulation occurred in 38.2%. Altogether, 19.1% of patients survived until ICU admission, and 5.1% were discharged alive. Only one CPR scene was in agreement with the published AHA guidelines. However, low-quality CPR and non-compliance with the guidelines resulted in favorable outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Patrickson W Clive

    2009-07-01

    Full Text Available Abstract Background Hands-Only cardiopulmonary resuscitation (CPR is recommended for use on adult victims of witnessed out-of-hospital (OOH sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2 CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. Methods Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level, and changes in electromyography and joint kinetics and kinematics. Results All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. Conclusion Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated

  17. A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation.

    Science.gov (United States)

    Trowbridge, Cynthia; Parekh, Jesal N; Ricard, Mark D; Potts, Jerald; Patrickson, W Clive; Cason, Carolyn L

    2009-07-07

    Hands-Only cardiopulmonary resuscitation (CPR) is recommended for use on adult victims of witnessed out-of-hospital (OOH) sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2) CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level), and changes in electromyography and joint kinetics and kinematics. All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated with Hands-Only CPR would offset the potential physiological

  18. Two decades of British newspaper coverage regarding do not attempt cardiopulmonary resuscitation decisions: Lessons for clinicians.

    Science.gov (United States)

    Beed, Martin; de Beer, Thearina; Brindley, Peter G

    2015-01-01

    To review UK newspaper reports relating to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in order to identify common themes and encourage dialogue. An online media database (LexisNexis(®)) was searched for UK Newspaper articles between 1993 and 2013 that referenced DNACPR decisions. Legal cases, concerning resuscitation decisions, were identified using two case law databases (Lexis Law(®) and Westlaw(®)), and referenced back to newspaper publications. All articles were fully reviewed. Three hundred and thirty one articles were identified, resulting from 77 identifiable incidents. The periods 2000-01 and 2011-13 encompassed the majority of articles. There were 16 high-profile legal cases, nine of which resulted in newspaper articles. Approximately 35 percent of newspaper reports referred to DNACPR decisions apparently made without adequate patient and/or family consultation. "Ageism" was referred to in 9 percent of articles (mostly printed 2000-02); and "discrimination against the disabled" in 8 percent (mostly from 2010-12). Only five newspaper articles (2 percent) discussed patients receiving CPR against their wishes. Eighteen newspaper reports (5 percent) associated DNACPR decisions with active euthanasia. Regarding DNACPR decision-making, the predominant theme was perceived lack of patient involvement, and, more recently, lack of surrogate involvement. Negative language was common, especially when decisions were presumed unilateral. Increased dialogue, and shared decision-making, is recommended. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses.

    Science.gov (United States)

    Shah, P S

    2009-10-01

    Studies of the outcomes of preterm infants after the receipt of extensive cardiopulmonary resuscitation (CPR) at birth or in the neonatal intensive care units (NICUs) have yielded varied results. A systematic review of the outcomes of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants who received extensive resuscitation at birth or in the NICU was carried out. MEDLINE, EMBASE, CINAHL databases were searched for studies of extensive CPR in the delivery room (DR-CPR) and in NICU (NICU-CPR) that have reported neonatal or long-term outcomes. A total of 20 eligible studies were identified (11 of DR-CPR, 7 of NICU-CPR and 2 had combined data). DR-CPR was associated with an increased risk of mortality (odds ratio (OR) 2.83, 95% confidence interval (CI) 1.92, 4.16) and severe neurological injury (OR 2.27, 95% CI 1.40, 3.67) compared with infants who did not receive extensive CPR. NICU-CPR was associated with an increased risk of mortality (OR 55, 95% CI 15, 195) compared with infants who did not receive CPR; however, confidence limits were wide. The long-term outcome of survivors was reported in a limited number of studies. Extensive CPR at birth or in the NICU for VLBW or ELBW infants was associated with higher risk of mortality.

  20. Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation.

    Science.gov (United States)

    Nehme, Ziad; Boyle, Malcolm J

    2009-02-20

    Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045). Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

  1. Ratio of Pediatric ICU versus Ward Cardiopulmonary Resuscitation Events is Increasing

    Science.gov (United States)

    Berg, Robert A.; Sutton, Robert M.; Holubkov, Richard; Nicholson, Carol E.; Dean, J. Michael; Harrison, Rick; Heidemann, Sabrina; Meert, Kathleen; Newth, Christopher; Moler, Frank; Pollack, Murray; Dalton, Heidi; Doctor, Allan; Wessel, David; Berger, John; Shanley, Thomas; Carcillo, Joseph; Nadkarni, Vinay M.

    2013-01-01

    Objective The aim of this study was to evaluate the relative frequency of pediatric in-hospital CPR events occurring in intensive care units (ICUs) compared to general wards. We hypothesized that the proportion of pediatric CPR provided in ICUs versus general wards has increased over the past decade and this shift is associated with improved resuscitation outcomes. Design Prospective, observational study. Setting Total of 315 hospitals in the American Heart Association’s Get With The Guidelines-Resuscitation (GTWG-R) database. Patients Total of 5,870 pediatric cardiopulmonary resuscitation (CPR) events between January 1, 2000 and September 14, 2010. CPR events were defined as external chest compressions >1minute. Measurements and Results The primary outcome was proportion of total ICU versus general ward CPR events over time evaluated by chi square test for trend. Secondary outcome included return of spontaneous circulation (ROSC) following the CPR event. Among 5870 pediatric CPR events, 5477 (93.3%) occurred in ICUs compared to 393 (6.7%) on inpatient wards. Over time, significantly more of these CPR events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87 - 91% vs. 2004-2010: 94 - 96%). In a multivariable model controlling for within center variability and other potential confounders, ROSC increased in 2004-2010 compared with 2000-2003 (RR 1.08, 95% confidence interval: 1.03-1.13). Conclusions In-hospital pediatric CPR is much more commonly provided in ICUs vs. Wards and the proportion has increased significantly over the past decade with concomitant increases in return of spontaneous circulation. PMID:23921270

  2. Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit.

    Science.gov (United States)

    Foglia, Elizabeth E; Langeveld, Robert; Heimall, Lauren; Deveney, Alyson; Ades, Anne; Jensen, Erik A; Nadkarni, Vinay M

    2017-01-01

    The contemporary characteristics and outcomes of cardiopulmonary resuscitation (CPR) in the neonatal intensive care unit (NICU) are poorly described. The objectives of this study were to determine the incidence, interventions, and outcomes of CPR in a quaternary referral NICU. Retrospective observational study of infants who received chest compressions for resuscitation in the Children's Hospital of Philadelphia NICU between April 1, 2011 and June 30, 2015. Patient, event, and survival characteristics were abstracted from the medical record and the hospital-wide resuscitation database. The primary outcome was survival to hospital discharge. Univariable and multivariable analyses were performed to identify patient and event factors associated with survival to discharge. There were 1.2 CPR events per 1000 patient days. CPR was performed in 113 of 5046 (2.2%) infants admitted to the NICU during the study period. The median duration of chest compressions was 2min (interquartile range 1, 6min). Adrenaline was administered in 34 (30%) CPR events. Of 113 infants with at least one CPR event, 69 (61%) survived to hospital discharge. Factors independently associated with decreased survival to hospital discharge were inotrope treatment prior to CPR (adjusted Odds Ratio [aOR] 0.14, 95% Confidence Interval [CI] 0.04, 0.54), and adrenaline administration during CPR (aOR 0.14, 95% CI 0.04, 0.50). Although it was not uncommon, the incidence of CPR was low (CPR and adrenaline administration during CPR were less likely to survive to hospital discharge. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Comparison of different inspiratory triggering settings in automated ventilators during cardiopulmonary resuscitation in a porcine model.

    Science.gov (United States)

    Tan, Dingyu; Xu, Jun; Shao, Shihuan; Fu, Yangyang; Sun, Feng; Zhang, Yazhi; Hu, Yingying; Walline, Joseph; Zhu, Huadong; Yu, Xuezhong

    2017-01-01

    Mechanical ventilation via automated in-hospital ventilators is quite common during cardiopulmonary resuscitation. It is not known whether different inspiratory triggering sensitivity settings of ordinary ventilators have different effects on actual ventilation, gas exchange and hemodynamics during resuscitation. 18 pigs enrolled in this study were anaesthetized and intubated. Continuous chest compressions and mechanical ventilation (volume-controlled mode, 100% O2, respiratory rate 10/min, and tidal volumes 10ml/kg) were performed after 3 minutes of ventricular fibrillation. Group trig-4, trig-10 and trig-20 (six pigs each) were characterized by triggering sensitivities of 4, 10 and 20 (cmH2O for pressure-triggering and L/min for flow-triggering), respectively. Additionally, each pig in each group was mechanically ventilated using three types of inspiratory triggering (pressure-triggering, flow-triggering and turned-off triggering) of 5 minutes duration each, and each animal matched with one of six random assortments of the three different triggering settings. Blood gas samples, respiratory and hemodynamic parameters for each period were all collected and analyzed. In each group, significantly lower actual respiratory rate, minute ventilation volume, mean airway pressure, arterial pH, PaO2, and higher end-tidal carbon dioxide, aortic blood pressure, coronary perfusion pressure, PaCO2 and venous oxygen saturation were observed in the ventilation periods with a turned-off triggering setting compared to those with pressure- or flow- triggering (all PVentilation with pressure- or flow-triggering tends to induce hyperventilation and deteriorating gas exchange and hemodynamics during CPR. A turned-off patient triggering or a pressure-triggering of 20 cmH2O is preferred for ventilation when an ordinary inpatient hospital ventilator is used during resuscitation.

  4. Cardiopulmonary resuscitation in the elderly: analysis of the events in the emergency department

    Directory of Open Access Journals (Sweden)

    Augusto Tricerri

    2013-10-01

    Full Text Available With the increasing number of old people in all western countries and increasing life expectancy at birth, many seniors spend the last period of their life with various afflictions that may lead to cardiac arrest. Bystander cardiopulmonary resuscitation (CPR increases survival rates. Octogenarians are the fastest growing segment of the population and despite empirical evidence that CPR is of questionable effectiveness in seniors with comorbidities, it is still the only treatment among life-sustaining ones. Cardiopulmonary resuscitation is frequently unsuccessful, but if survival is achieved, a fairly good quality of life can be expected. Various papers analyzed the effect of CPR in hospitalized patients or in cardiac arrest occurring at home or in public places, while less is known about events occurring in the emergency room (ER. We performed a retrospective analysis of cardiac arrest events occurred in ER within 54 months: we analyzed 415,001 records of ER visits (from 01/01/1999 to 30/06/2003 in San Giovanni Addolorata Hospital. Data were analyzed in terms of age and outcome. We identified 475 records with the outcome of death in ER or death on arrival. Out of them, we selected 290 medical records which had sufficient data to be analyzed. Of the 290 patients evaluated, 225 died in ER, 18 were deemed to die on arrival, and 47 survived the cardiac arrest and were admitted to intensive care unit (ICU. The overall mortality was 0.11%, while the incidence of the selected events was 0.072%. The mean age of the analyzed population was 71.3 years. The only possible diagnosis was often cardiac arrest, though most of the times we could specify and group the diagnosis even better. The analysis of the procedures showed that cardiac arrest treated by direct current (DC shock was similarly distributed in different age groups, and no difference was detectable between the two groups. The mean age of the patients who underwent tracheal intubation (TI was

  5. [Effects of anisodamine on microcirculation of the asystole rats during the cardiopulmonary resuscitation].

    Science.gov (United States)

    Jia, Li-Jing; Chen, Wei; Shen, Hong; Ji, Da; Zhao, Xiu-Mei; Liu, Xiu-Hua

    2008-12-01

    To study the effects of anisodamine (Ani) on microcirculation and reperfusion volume of intestine wall in Wistar rats during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Healthy Wistar rats subjected to CA and resuscitation were randomly divided into four groups, 15 rats in each group. After a 4-minute-non-intervention interval, CPR was started. After CPR for 4 minutes the animals in control group received normal saline, group epinephrine (Epi) received Epi (bolus dose of 200 microg/kg), Epi plus low dosage Ani (Ld Ani) group received Epi plus Ani (bolus dose of 200 microg/kg Epi followed by Ani of 5 mg/kg), and Epi plus high dosage Ani (Hd Ani) group received Epi plus Ani (bolus dose of 200 microg/kg Epi followed by Ani of 10 mg/kg). The recanalization rate of mesenteric arterioles and venules, caliber of the recanalized mesentery arteriole and venule, and the reperfusion volume of intestine wall were observed in vivo in rats with restoration of spontaneous circulation (ROSC). As the rate of recanalization of mesenteric arterioles and venules was compared, group Hd Ani (66.6%, 60.0%)>group Ld Ani (60.0%, 53.3%)>group control (40.0%, 40.0%)>group Epi (26.7%, 20.0%), and group Ld Ani and group Hd Ani was much better than group Epi(all Pgroup Ld Ani>group control>group Epi 30 minutes and 60 minutes after ROSC. Thirty minutes after ROSC, the caliber of arterioles and venules was much larger in group Ld Ani and group Hd Ani than that in group Epi (all Pintestine wall in group Ld Ani and group Hd Ani was higher than that in groups control and Epi 15 minutes after ROSC, and it kept on to be better up to 60 minutes after ROSC. Administration of Ani at earlier period of resuscitation could improve microcirculation of the tissue and raise ROSC rate and successful rate of resuscitation.

  6. End-tidal CO2 Detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resuscitation Following Asystole in Asphyxiated Piglets

    OpenAIRE

    Chalak, Lina F.; Barber, Chad A.; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H.

    2011-01-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO2 (ETCO2) monitoring may provide a continuous non-invasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO2 value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO2 that is associated with ROSC following ...

  7. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2013-05-01

    Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources. The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts. Die slagoffers van padongelukke, asook persone wat hart- en ander mediese noodtoestande ervaar, kan hulle lewens verloor omdat daar nie opgeleide personeel met funksionele toerusting en voldoende hulpbronne beskikbaar is om effektiewe kardiopulmonale resussitasie (KPR te doen nie. Die studie het ten doel

  8. Afraid of being "witchy with a 'b'": a qualitative study of how gender influences residents' experiences leading cardiopulmonary resuscitation.

    Science.gov (United States)

    Kolehmainen, Christine; Brennan, Meghan; Filut, Amarette; Isaac, Carol; Carnes, Molly

    2014-09-01

    Ineffective leadership during cardiopulmonary resuscitation ("code") can negatively affect a patient's likelihood of survival. In most teaching hospitals, internal medicine residents lead codes. In this study, the authors explored internal medicine residents' experiences leading codes, with a particular focus on how gender influences the code leadership experience. The authors conducted individual, semistructured telephone or in-person interviews with 25 residents (May 2012 to February 2013) from 9 U.S. internal medicine residency programs. They audio recorded and transcribed the interviews and then thematically analyzed the transcribed text. Participants viewed a successful code as one with effective leadership. They agreed that the ideal code leader was an authoritative presence; spoke with a deep, loud voice; used clear, direct communication; and appeared calm. Although equally able to lead codes as their male colleagues, female participants described feeling stress from having to violate gender behavioral norms in the role of code leader. In response, some female participants adopted rituals to signal the suspension of gender norms while leading a code. Others apologized afterwards for their counternormative behavior. Ideal code leadership embodies highly agentic, stereotypical male behaviors. Female residents employed strategies to better integrate the competing identities of code leader and female gender. In the future, residency training should acknowledge how female gender stereotypes may conflict with the behaviors required to enact code leadership and offer some strategies, such as those used by the female residents in this study, to help women integrate these dual identities.

  9. Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study.

    Science.gov (United States)

    Wang, Juan; Zhuo, Chao-Nan; Zhang, Lei; Gong, Yu-Shun; Yin, Chang-Lin; Li, Yong-Qin

    2015-01-01

    The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation (CPR) in training of military medical university students during a prolonged basic life support (BLS). A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed. The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 mL and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth (46.7±4.8 vs. 54.6±4.8 mm, P<0.001) and adequate compression rate (35.5%±26.5% vs. 76.1%±25.1%, P<0.001) were observed in female students. CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.

  10. National neonatal resuscitation training program in Nigeria (2008 ...

    African Journals Online (AJOL)

    Background: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal ...

  11. Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan

    International Nuclear Information System (INIS)

    Zamir, Q.; Nadeem, A.; Rizvi, A.H.

    2012-01-01

    Objective: To assess the level of awareness regarding basic and practical knowledge of cardiopulmonary resuscitation and its importance in the eyes of medical/dental students and doctors. Methods: The cross-sectional study was conducted in medical and dental colleges as well as hospitals of Rawalpindi and Islamabad, Pakistan, from June to September 2011. Non-probability convenience sampling was used and structured questionnaires on basic and practical knowledge of the procedure were distributed. The questionnaire had 26 items related to basic and advanced knowledge of the required skills. Doctors were divided into two groups based on their years of service and practice. Those with less than 5 years' experience were grouped as junior doctors, while rest as senior doctors. Descriptive statistics were employed to analyse the data using SPPS version 17 and Microsoft Excel. Percentages were worked out and the results were interpreted. Result: Of the 1000 questionnaires distributed, 646 (64.6%) were received duly filled and represented the study sample. Of the 646 participants, 34 (5.26%) were dentists, 424 (65.63%) were medical students, 92 (14.24%) were doctors and 96 (14.86%) were dental students. Basic knowledge of doctors was found to be better than that of dentists (n=96; 50% vs. n=8; 23%). Similarly, the advance knowledge of doctors was better than the dentists (n=53; 58% vs. n=11; 31%). The basic knowledge of junior doctors was found to be almost equal to the senior doctors (n=26; 44.75% vs. n=15; 45.5%). The advance knowledge of junior doctors was found to be better than the senior doctors (n=27; 45.37% vs. n=10; 29.48%). Among the students, 157 (37%) of the medical students had basic knowledge of CPR, while 36 (38%) dental students had basic knowledge of the topic. Medical students had more advanced knowledge (n=157; 37%) than dental students (n=34; 35%). Conclusion: The awareness of basic and advance knowledge of cardiopulmonary resuscitation skills in medical

  12. Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes.

    Science.gov (United States)

    Polimenakos, Anastasios C; Wojtyla, Patrice; Smith, Pamela J; Rizzo, Vincent; Nater, Melissa; El Zein, Chawki F; Ilbawi, Michel N

    2011-12-01

    Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR. Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted. Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78 kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7 min (p = 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH0.05). ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes. Copyright © 2011 European Association for

  13. Acid base, electrolyte, glucose, and lactate values during cardiopulmonary resuscitation in dogs and cats.

    Science.gov (United States)

    Hopper, Kate; Borchers, Angela; Epstein, Steven E

    2014-01-01

    To report acid base, electrolyte, glucose, and lactate values collected during or immediately after cardiopulmonary resuscitation (CPR) in dogs and cats. Retrospective study. University Teaching Hospital. Thirty-two dogs and 10 cats. None. Blood gas, electrolyte, glucose, and lactate values measured during CPR or within 5 minutes of return of spontaneous circulation (ROSC) were retrospectively evaluated. The time of blood collection with respect to the occurrence of cardiopulmonary arrest (CPA), the initiation of CPR or ROSC was noted. Forty-two venous blood samples were analyzed, 24 collected during CPR and 18 samples were collected within 5 minutes of ROSC. Metabolic acidosis and hyperlactatemia were evident in all samples in the study while an increased PvCO2 occurred in 88% of samples collected during CPR and in 61% of samples collected following ROSC. Hyperkalemia occurred in 65% of all cases, decreased ionized calcium was evident in 18%, hypoglycemia was evident in 21% while hyperglycemia was evident in 62%. There was no significant difference in any parameter evaluated between dogs and cats during CPR. There was no significant difference of any variable measured during the first 15 minutes of CPA versus those measured more than 15 minutes following CPA. When the values measured during the first 5 minutes of ROSC were compared to those measured during CPR, the pH and PvO2 were significantly lower in the CPR group. Biochemical abnormalities including metabolic acidosis, hyperkalemia, ionized hypocalcemia, hypoglycemia, and hyperglycemia can be identified during CPR and immediately following ROSC. The therapeutic and prognostic relevance of these changes are yet to be defined and may prove to be useful to guide patient management in the future. © Veterinary Emergency and Critical Care Society 2014.

  14. Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance.

    Science.gov (United States)

    McDonald, Catherine H; Heggie, James; Jones, Christopher M; Thorne, Christopher J; Hulme, Jonathan

    2013-08-01

    Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance. 62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery. 49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue. Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.

  15. Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Boyle Malcolm J

    2009-02-01

    Full Text Available Abstract Background Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. Methods An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Results Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015 and 23% reduction in suboptimal minute volumes (p = 0.045. Conclusion Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

  16. Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country.

    Science.gov (United States)

    Suraseranivongse, Suwannee; Chawaruechai, Thanawin; Saengsung, Parichart; Komoltri, Chulaluk

    2006-11-01

    To evaluate the outcome and quality of in-hospital cardiopulmonary resuscitation (CPR), and factors affecting the outcome. A 2300-bed university hospital in Thailand. A 1-year prospective audit according to the Utstein style. A total of 639 cardiac arrests (370 male, 269 female, age 1 day-96 years, mean+/-S.D.=53.3+/-24.12 years) were included. Four hundred and thirty-three cardiac arrests (67.8%) occurred in non-monitored areas and 200 (31.3%) occurred in monitored areas. Five hundred and thirty-six cardiac arrests (84%) were witnessed. The majority of cardiac arrests occurred in medical patients (68.4%) and surgical patients (21.4%). The most common underlying causes of arrest were respiratory failure (24.7%) and septic shock (23.3%). Initial ECG rhythms were ventricular fibrillation 79 (12.4%), asystole 272 (42.6%) with pulseless electrical activity 225 (35.2%). Most patients received basic life support within 1 min (86.7%) and advanced life support (ALS) within 4 min (92.6%) but only 25% of patients received defibrillation within 3 min. Following resuscitation, 394 (61.7%) achieved restoration of spontaneous circulation and 44 patients (6.9%) survived to discharge. Only 162 post-arrest patients were treated in the critical care area. The initial survival rate was not associated with sex, age and time to ALS, but was significantly related to the monitored area. In our setting, survival to discharge is 6.9%. Initial survival rate was strongly associated with being in a monitored area. Defibrillators and the critical care areas were insufficient.

  17. Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats - A Pilot Trial.

    Directory of Open Access Journals (Sweden)

    Andreas Schober

    Full Text Available Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR and extracorporeal cardiopulmonary life support (ECLS are poorly explored. Markers are needed for a more personalized resuscitation and post-resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during ventricular fibrillation cardiac arrest (VF-CA and ECLS versus conventional CPR. Male Sprague-Dawley rats (350g underwent 8min untreated VF-CA followed by ECLS (n = 8; bloodflow 100ml/kg, mechanical CPR (n = 18; 200/min until return of spontaneous circulation (ROSC. Shams (n = 2 were included. Glucose, glutamate and lactate/pyruvate ratio were compared between treatment groups and animals with and without ROSC. Ten animals (39% achieved ROSC (ECLS 5/8 vs. CPR 5/18; OR 4,3;CI:0.7-25;p = 0.189. During VF-CA central nervous glucose decreased (0.32±0.1mmol/l to 0.04±0.01mmol/l; p<0.001 and showed a significant rise (0.53±0.1;p<0.001 after resuscitation. Lactate/pyruvate (L/P ratio showed a 5fold increase (31 to 164; p<0.001; maximum 8min post ROSC. Glutamate showed a 3.5-fold increase to (2.06±1.5 to 7.12±5.1μmol/L; p<0.001 after CA. All parameters normalized after ROSC with no significant differences between ECLS and CPR. Metabolic changes during ischemia and resuscitation can be displayed by cerebral microdialysis in our VF-CA CPR and ECLS rat model. We found similar microdialysate concentrations and patterns of normalization in both resuscitation methods used. Institutional Protocol Number: GZ0064.11/3b/2011.

  18. Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats – A Pilot Trial

    Science.gov (United States)

    Schober, Andreas; Warenits, Alexandra M.; Testori, Christoph; Weihs, Wolfgang; Hosmann, Arthur; Högler, Sandra; Sterz, Fritz; Janata, Andreas; Scherer, Thomas; Magnet, Ingrid A. M.; Ettl, Florian; Laggner, Anton N.; Herkner, Harald; Zeitlinger, Markus

    2016-01-01

    Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary life support (ECLS) are poorly explored. Markers are needed for a more personalized resuscitation and post—resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during ventricular fibrillation cardiac arrest (VF-CA) and ECLS versus conventional CPR. Male Sprague-Dawley rats (350g) underwent 8min untreated VF-CA followed by ECLS (n = 8; bloodflow 100ml/kg), mechanical CPR (n = 18; 200/min) until return of spontaneous circulation (ROSC). Shams (n = 2) were included. Glucose, glutamate and lactate/pyruvate ratio were compared between treatment groups and animals with and without ROSC. Ten animals (39%) achieved ROSC (ECLS 5/8 vs. CPR 5/18; OR 4,3;CI:0.7–25;p = 0.189). During VF-CA central nervous glucose decreased (0.32±0.1mmol/l to 0.04±0.01mmol/l; p<0.001) and showed a significant rise (0.53±0.1;p<0.001) after resuscitation. Lactate/pyruvate (L/P) ratio showed a 5fold increase (31 to 164; p<0.001; maximum 8min post ROSC). Glutamate showed a 3.5-fold increase to (2.06±1.5 to 7.12±5.1μmol/L; p<0.001) after CA. All parameters normalized after ROSC with no significant differences between ECLS and CPR. Metabolic changes during ischemia and resuscitation can be displayed by cerebral microdialysis in our VF-CA CPR and ECLS rat model. We found similar microdialysate concentrations and patterns of normalization in both resuscitation methods used. Institutional Protocol Number: GZ0064.11/3b/2011 PMID:27175905

  19. Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats - A Pilot Trial.

    Science.gov (United States)

    Schober, Andreas; Warenits, Alexandra M; Testori, Christoph; Weihs, Wolfgang; Hosmann, Arthur; Högler, Sandra; Sterz, Fritz; Janata, Andreas; Scherer, Thomas; Magnet, Ingrid A M; Ettl, Florian; Laggner, Anton N; Herkner, Harald; Zeitlinger, Markus

    2016-01-01

    Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary life support (ECLS) are poorly explored. Markers are needed for a more personalized resuscitation and post-resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during ventricular fibrillation cardiac arrest (VF-CA) and ECLS versus conventional CPR. Male Sprague-Dawley rats (350g) underwent 8min untreated VF-CA followed by ECLS (n = 8; bloodflow 100ml/kg), mechanical CPR (n = 18; 200/min) until return of spontaneous circulation (ROSC). Shams (n = 2) were included. Glucose, glutamate and lactate/pyruvate ratio were compared between treatment groups and animals with and without ROSC. Ten animals (39%) achieved ROSC (ECLS 5/8 vs. CPR 5/18; OR 4,3;CI:0.7-25;p = 0.189). During VF-CA central nervous glucose decreased (0.32±0.1mmol/l to 0.04±0.01mmol/l; p<0.001) and showed a significant rise (0.53±0.1;p<0.001) after resuscitation. Lactate/pyruvate (L/P) ratio showed a 5fold increase (31 to 164; p<0.001; maximum 8min post ROSC). Glutamate showed a 3.5-fold increase to (2.06±1.5 to 7.12±5.1μmol/L; p<0.001) after CA. All parameters normalized after ROSC with no significant differences between ECLS and CPR. Metabolic changes during ischemia and resuscitation can be displayed by cerebral microdialysis in our VF-CA CPR and ECLS rat model. We found similar microdialysate concentrations and patterns of normalization in both resuscitation methods used. Institutional Protocol Number: GZ0064.11/3b/2011.

  20. Transthoracic impedance for the monitoring of quality of manual chest compression during cardiopulmonary resuscitation.

    Science.gov (United States)

    Zhang, Hehua; Yang, Zhengfei; Huang, Zitong; Chen, Bihua; Zhang, Lei; Li, Heng; Wu, Baoming; Yu, Tao; Li, Yongqin

    2012-10-01

    The quality of cardiopulmonary resuscitation (CPR), especially adequate compression depth, is associated with return of spontaneous circulation (ROSC) and is therefore recommended to be measured routinely. In the current study, we investigated the relationship between changes of transthoracic impedance (TTI) measured through the defibrillation electrodes, chest compression depth and coronary perfusion pressure (CPP) in a porcine model of cardiac arrest. In 14 male pigs weighing between 28 and 34 kg, ventricular fibrillation (VF) was electrically induced and untreated for 6 min. Animals were randomized to either optimal or suboptimal chest compression group. Optimal depth of manual compression in 7 pigs was defined as a decrease of 25% (50 mm) in anterior posterior diameter of the chest, while suboptimal compression was defined as 70% of the optimal depth (35 mm). After 2 min of chest compression, defibrillation was attempted with a 120-J rectilinear biphasic shock. There were no differences in baseline measurements between groups. All animals had ROSC after optimal compressions; this contrasted with suboptimal compressions, after which only 2 of the animals had ROSC (100% vs. 28.57%, p=0.021). The correlation coefficient was 0.89 between TTI amplitude and compression depth (pcompression depth and CPP in this porcine model of cardiac arrest. The TTI measured from defibrillator electrodes, therefore has the potential to serve as an indicator to monitor the quality of chest compression and estimate CPP during CPR. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Relationship between weight of rescuer and quality of chest compression during cardiopulmonary resuscitation.

    Science.gov (United States)

    Hasegawa, Tomoyuki; Daikoku, Rie; Saito, Shin; Saito, Yayoi

    2014-06-24

    According to the guidelines for cardiopulmonary resuscitation (CPR), the rotation time for chest compression should be about 2 min. The quality of chest compressions is related to the physical fitness of the rescuer, but this was not considered when determining rotation time. The present study aimed to clarify associations between body weight and the quality of chest compression and physical fatigue during CPR performed by 18 registered nurses (10 male and 8 female) assigned to light and heavy groups according to the average weight for each sex in Japan. Five-minute chest compressions were then performed on a manikin that was placed on the floor. Measurement parameters were compression depth, heart rate, oxygen uptake, integrated electromyography signals, and rating of perceived exertion. Compression depth was evaluated according to the ratio (%) of adequate compressions (at least 5 cm deep). The ratio of adequate compressions decreased significantly over time in the light group. Values for heart rate, oxygen uptake, muscle activity defined as integrated electromyography signals, and rating of perceived exertion were significantly higher for the light group than for the heavy group. Chest compression caused increased fatigue among the light group, which consequently resulted in a gradual fall in the quality of chest compression. These results suggested that individuals with a lower body weight should rotate at 1-min intervals to maintain high quality CPR and thus improve the survival rates and neurological outcomes of victims of cardiac arrest.

  2. Computed tomography during cardiopulmonary resuscitation using automated chest compression devices - an initial study

    International Nuclear Information System (INIS)

    Wirth, Stefan; Koerner, Markus; Treitl, Marcus; Linsenmaier, Ulrich; Reiser, Maximilian F.; Leidel, Bernd A.; Jaschkowitz, Thomas; Kanz, Karl G.

    2009-01-01

    The purpose of the study was to evaluate both CT image quality in a phantom study and feasibility in an initial case series using automated chest compression (A-CC) devices for cardiopulmonary resuscitation (CPR). Multidetector CT (MDCT) of a chest/heart phantom (Thorax-CCI, QRM, Germany) was performed with identical protocols of the phantom alone (S), the phantom together with two different A-CC devices (A: AutoPulse, Zoll, Germany; L: LUCAS, Jolife, Sweden), and the phantom with a LUCAS baseplate, but without the compression unit (L-bp). Nine radiologists evaluated image noise quantitatively (n=244 regions, Student's t-test) and also rated image quality subjectively (1-excellent to 6-inadequate, Mann-Whitney U-test). Additionally, three patients during prolonged CPR underwent CT with A-CC devices. Mean image noise of S was increased by 1.21 using L-bp, by 3.62 using A, and by 5.94 using L (p<0.01 each). Image quality was identical using S and L-bp (1.64 each), slightly worse with A (1.83), and significantly worse with L (2.97, p<0.001). In all patient cases the main lesions were identified, which led to clinical key decisions. Image quality was excellent with L-bp and good with A. Under CPR conditions initial cases indicate that MDCT diagnostics supports either focused treatment or the decision to terminate efforts. (orig.)

  3. Chest Compression With Personal Protective Equipment During Cardiopulmonary Resuscitation: A Randomized Crossover Simulation Study.

    Science.gov (United States)

    Chen, Jie; Lu, Kai-Zhi; Yi, Bin; Chen, Yan

    2016-04-01

    Following a chemical, biological, radiation, and nuclear incident, prompt cardiopulmonary resuscitation (CPR) procedure is essential for patients who suffer cardiac arrest. But CPR when wearing personal protection equipment (PPE) before decontamination becomes a challenge for healthcare workers (HCW). Although previous studies have assessed the impact of PPE on airway management, there is little research available regarding the quality of chest compression (CC) when wearing PPE.A present randomized cross-over simulation study was designed to evaluate the effect of PPE on CC performance using mannequins.The study was set in one university medical center in the China.Forty anesthesia residents participated in this randomized cross-over study.Each participant performed 2 min of CC on a manikin with and without PPE, respectively. Participants were randomized into 2 groups that either performed CC with PPE first, followed by a trial without PPE after a 180-min rest, or vice versa.CPR recording technology was used to objectively quantify the quality of CC. Additionally, participants' physiological parameters and subjective fatigue score values were recorded.With the use of PPE, a significant decrease of the percentage of effective compressions (41.3 ± 17.1% with PPE vs 67.5 ± 15.6% without PPE, P disadvantage for enhancing survival of cardiac arrest.

  4. A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation.

    Science.gov (United States)

    Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Cho, Young Soon; Chung, Sung Phil; Park, Incheol

    2012-01-01

    Metronome guidance is a simple and economical feedback system for guiding cardiopulmonary resuscitation (CPR). However, a recent study showed that metronome guidance reduced the depth of chest compression. The results of previous studies suggest that a higher chest compression rate is associated with a better CPR outcome as compared with a lower chest compression rate, irrespective of metronome use. Based on this finding, we hypothesized that a lower chest compression rate promotes a reduction in chest compression depth in the recent study rather than metronome use itself. One minute of chest compression-only CPR was performed following the metronome sound played at 1 of 4 different rates: 80, 100, 120, and 140 ticks/min. Average compression depths (ACDs) and duty cycles were compared using repeated measures analysis of variance, and the values in the absence and presence of metronome guidance were compared. Both the ACD and duty cycle increased when the metronome rate increased (P = .017, CPR procedures following the metronome rates of 80 and 100 ticks/min were significantly lower than those for the procedures without metronome guidance. The ACD and duty cyle for chest compression increase as the metronome rate increases during metronome-guided CPR. A higher rate of chest compression is necessary for metronome-guided CPR to prevent suboptimal quality of chest compression. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

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    Renata Maria de Oliveira Botelho

    Full Text Available ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR. Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60 was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51 received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017 or the occurrence of death (p=0.8112. Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

  6. Evaluation of upper body muscle activity during cardiopulmonary resuscitation performance in simulated microgravity

    Science.gov (United States)

    Waye, A. B.; Krygiel, R. G.; Susin, T. B.; Baptista, R.; Rehnberg, L.; Heidner, G. S.; de Campos, F.; Falcão, F. P.; Russomano, T.

    2013-09-01

    Performance of efficient single-person cardiopulmonary resuscitation (CPR) is vital to maintain cardiac and cerebral perfusion during the 2-4 min it takes for deployment of advanced life support during a space mission. The aim of the present study was to investigate potential differences in upper body muscle activity during CPR performance at terrestrial gravity (+1Gz) and in simulated microgravity (μG). Muscle activity of the triceps brachii, erector spinae, rectus abdominis and pectoralis major was measured via superficial electromyography in 20 healthy male volunteers. Four sets of 30 external chest compressions (ECCs) were performed on a mannequin. Microgravity was simulated using a body suspension device and harness; the Evetts-Russomano (ER) method was adopted for CPR performance in simulated microgravity. Heart rate and perceived exertion via Borg scores were also measured. While a significantly lower depth of ECCs was observed in simulated microgravity, compared with +1Gz, it was still within the target range of 40-50 mm. There was a 7.7% decrease of the mean (±SEM) ECC depth from 48 ± 0.3 mm at +1Gz, to 44.3 ± 0.5 mm during microgravity simulation (p fatiguing than at +1Gz. Nevertheless, no significant difference in muscle activity between conditions was found, a result that is favourable for astronauts, given the inevitable muscular and cardiovascular deconditioning that occurs during space travel.

  7. Rescuers' physical fatigue with different chest compression to ventilation methods during simulated infant cardiopulmonary resuscitation.

    Science.gov (United States)

    Boldingh, Anne Marthe; Jensen, Thomas Hagen; Bjørbekk, Ane Torvik; Solevåg, Anne Lee; Nakstad, Britt

    2016-10-01

    To assess development of objective, subjective and indirect measures of fatigue during simulated infant cardiopulmonary resuscitation (CPR) with two different methods. Using a neonatal manikin, 17 subject-pairs were randomized in a crossover design to provide 5-min CPR with a 3:1 chest compression (CC) to ventilation (C:V) ratio and continuous CCs at a rate of 120 min(-1) with asynchronous ventilations (CCaV-120). We measured participants' changes in heart rate (HR) and mean arterial pressure (MAP); perceived level of fatigue on a validated Likert scale; and manikin CC measures. CCaV-120 compared with a 3:1 C:V ratio resulted in a change during 5-min of CPR in HR 49 versus 40 bpm (p = 0.01), and MAP 1.7 versus -2.8 mmHg (p = 0.03); fatigue rated on a Likert scale 12.9 versus 11.4 (p = 0.2); and a significant decay in CC depth after 90 s (p = 0.03). The results indicate a trend toward more fatigue during simulated CPR in CCaV-120 compared to the recommended 3:1 C:V CPR. These results support current guidelines.

  8. Respiratory function and near infrared spectroscopy recording during cardiopulmonary resuscitation in an extremely preterm newborn.

    Science.gov (United States)

    Li, Elliott S; Cheung, Po-Yin; Pichler, Gerhard; Aziz, Khalid; Schmölzer, Georg M

    2014-01-01

    We describe a case highlighting several controversial and important topics regarding neonatal cardiopulmonary resuscitation (CPR). Current neonatal guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective ratio of delivering chest compressions (CC) remains controversial. We report a case of a male infant at 24 weeks' postmenstrual age weighing 650 g on a background of preterm labor. At initial assessment the infant appeared floppy and apneic with a heart rate (HR) of 50-60 beats/min. Mask ventilation was ineffective, thus continuous CC (90/min) with asynchronous ventilations (60/min) was started. HR, blood pressure, oxygen saturation, cerebral oxygenation, respiratory function, and exhaled carbon dioxide (ECO2) were continuously measured during CPR. Return of spontaneous circulation defined as HR >60/min was achieved after 90 s of CPR. Mask leak significantly increased during CC. During bradycardia (HR ∼50/min), ECO2 indicated correct tube placement and an increase of ECO2 >12 mm Hg was associated with rapid increase in HR >60/min. © 2014 S. Karger AG, Basel.

  9. Reliability of pulse oximetry during cardiopulmonary resuscitation in a piglet model of neonatal cardiac arrest.

    Science.gov (United States)

    Hassan, Mohammad Ahmad; Mendler, Marc; Maurer, Miriam; Waitz, Markus; Huang, Li; Hummler, Helmut D

    2015-01-01

    Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during cardiopulmonary resuscitation (CPR). In a prospective cohort study in 30 healthy newborn piglets, cardiac arrest was induced, and thereafter each piglet received CPR for 20 min. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2). Arterial blood was analyzed for functional oxygenation (SaO2) every 2 min. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond ±5%. Bias values were decreased at the baseline measurements (mean: 2.5 ± 4.6%) with higher precision and accuracy compared with values across the experiment. Two minutes after cardiac arrest, there was a marked decrease in precision and accuracy as well as an increase in bias up to 13 ± 34%, reaching a maximum of 45.6 ± 28.3% after 10 min over a mean SaO2 range of 29-58%. Pulse oximetry showed increased bias and decreased accuracy and precision during CPR in a model of neonatal cardiac arrest. We recommend further studies to clarify the exact mechanisms of these false readings to improve reliability of pulse oximetry during the marked desaturation and hypoperfusion found during CPR. © 2014 S. Karger AG, Basel.

  10. Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015

    Directory of Open Access Journals (Sweden)

    Hae-Sung Nam

    2017-11-01

    Full Text Available OBJECTIVES During the outbreak of the Middle East Respiratory Syndrome (MERS in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC. METHODS We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure. RESULTS The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR. CONCLUSIONS The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

  11. Analysis of the YouTube videos on basic life support and cardiopulmonary resuscitation.

    Science.gov (United States)

    Tourinho, Francis Solange Vieira; de Medeiros, Kleyton Santos; Salvador, Pétala Tuani Candido De Oliveira; Castro, Grayce Loyse Tinoco; Santos, Viviane Euzébia Pereira

    2012-01-01

    To analyze the videos on the YouTube video sharing site, noting which points addressed in the videos related to CPR and BLS, based on the 2010 Guidelines for the American Heart Association (AHA). This was an exploratory, quantitative and qualitative research performed in the YouTube sharing site, using as keywords the expressions in Portuguese equivalent to the Medical Subject Headings (MeSH) "Cardiopulmonary Resuscitation" and "Basic Life Support" for videos that focused on the basic life support. The research totaled 260 videos over the two searches. Following the exclusion criteria, 61 videos remained. These mostly are posted by individuals and belong to the category Education. Moreover, most of the videos, despite being added to the site after the publication of the 2010 AHA Guidelines, were under the older 2005 guidelines. Although the video-sharing site YouTube is widely used today, it lacks videos about CPR and BLS that comply to the most recent AHA recommendations, which may negatively influence the population that uses it.

  12. Accuracy of a feedback device for cardiopulmonary resuscitation on a dental chair.

    Science.gov (United States)

    Segal, Nicolas; Laurent, Florian; Maman, Louis; Plaisance, Patrick; Augustin, Pascal

    2012-11-01

    Conflicting studies exist about the effectiveness of cardiopulmonary resuscitation (CPR) on a dental chair. In some situations, dental surgeons are obliged to perform CPR with the patient on the chair. Feedback devices are supposed to guide the compression depth in order to improve the quality of CPR, but some devices are based on an accelerometer that can theoretically report erroneous results because of the lack of rigidity of a dental chair. The aim of this study was to evaluate the accuracy of these devices to guide chest compressions on a dental chair. A prospective, randomised, crossover, equivalence/non-inferiority study was conducted to compare the values of compression depths provided by the feedback device (Real CPR Help(®), delivered by Zoll© Medical Corporation, Chelmsford, MA, USA) with the real measurements provided by the manikin (Resusci Anne(®) Advanced SkillTrainer, Laerdal Medical AS©, Norway). Chest-compression-only CPR was performed by 15 Basic Life Support instructors who carried out two rounds of continuous CPR for 2 min each. Data were analysed with a correlation test, a Bland-Altman method and a Wilcoxon test. Statistical significance was defined as pdental chair and on the floor (pdental chairs.

  13. Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka.

    Science.gov (United States)

    Beane, Abi; Ambepitiyawaduge, Pubudu De Silva; Thilakasiri, Kaushila; Stephens, Tim; Padeniya, Anuruddha; Athapattu, Priyantha; Mahipala, Palitha G; Sigera, Ponsuge Chathurani; Dondorp, Arjen M; Haniffa, Rashan

    2017-12-01

    The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a little bit surprised" by the arrest. CPR attempts before death in hospitals across Sri Lanka is prevalent. DNAR use remains uncommon.

  14. Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study.

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    Christoph Castan

    Full Text Available Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation.Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario.The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107-270 s, more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49 was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17% of the overall time needed for defibrillation (maximum 67%. Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused.Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of

  15. Survival after in-hospital cardiopulmonary resuscitation in a major referral center

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    Saghafinia Masoud

    2010-01-01

    Full Text Available Aim: This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation (CPR, by the code blue team at our center to compare with other centers. Materials and Methods: Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests. Results: Of the 290 patients included, 95 patients (30.4% had successful CPR. However, only 35 patients (12% were alive at discharge. The majority requiring CPR were above 60 years of age (61.7%. Males required CPR more than females. There were 125 women (43.1% and 165 males (56.9% aged 3 to 78 (average 59.6 years. Majority (179 of the cases (61.7% were above 60 years of age. Regarding the various wards, 54 cases (17.3% were in the internal medicine ward, 63 cases (20.1% in the surgery ward, 1 case (0.3% in the clinic, 11 cases (3.5% in the paraclinic, 116 cases (37.1% in the emergency (ER, 55 cases (17.5% in the Intensive Care Unit (ICU and Coronary Care Unit (CCU, and 13 cases (4.2% were in other wards. Cardiac massage was done in 133 cases (42.5%, defibrillation only via electroshock 3 cases (1%, and both were used in177 cases (56.5%. The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases. Conclusion: In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR> 10 minutes was predictive of significantly decreased survival to discharge.

  16. Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning.

    Science.gov (United States)

    Claesson, Andreas; Karlsson, Tomas; Thorén, Ann-Britt; Herlitz, Johan

    2011-11-01

    To describe time delay during surf rescue and compare the quality of cardiopulmonary resuscitation (CPR) before and after exertion in surf lifeguards. A total of 40 surf lifeguards at the Tylösand Surf Lifesaving Club in Sweden (65% men; age, 19-43 years) performed single-rescuer CPR for 10 minutes on a Laerdal SkillmeteÔ Resusci Anne manikin. The test was repeated with an initial simulated surf rescue on an unconscious 80-kg victim 100 m from the shore. The time to victim, to first ventilation, and to the start of CPR was documented. The mean time in seconds to the start of ventilations in the water was 155 ± 31 (mean ± SD) and to the start of CPR, 258 ± 44. Men were significantly faster during rescue (mean difference, 43 seconds) than women (P = .002). The mean compression depth (millimeters) at rest decreased significantly from 0-2 minutes (42.6 ± 7.8) to 8-10 minutes (40.8 ± 9.3; P = .02). The mean compression depth after exertion decreased significantly (44.2 ± 8.7 at 0-2 minutes to 41.5 ± 9.1 at 8-10 minutes; P = .0008). The compression rate per minute decreased after rescue from 117.2 ±14.3 at 0 to 2 minutes to 114.1 ± 16.1 after 8 to 10 minutes (P = .002). The percentage of correct compressions at 8 to 10 minutes was identical before and after rescue (62%). In a simulated drowning, 100 m from shore, it took twice as long to bring the patient back to shore as to reach him; and men were significantly faster. Half the participants delivered continuous chest compressions of more than 38 mm during 10 minutes of single-rescuer CPR. The quality was identical before and after surf rescue. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Effects of flashlight guidance on chest compression performance in cardiopulmonary resuscitation in a noisy environment.

    Science.gov (United States)

    You, Je Sung; Chung, Sung Phil; Chang, Chul Ho; Park, Incheol; Lee, Hye Sun; Kim, SeungHo; Lee, Hahn Shick

    2013-08-01

    In real cardiopulmonary resuscitation (CPR), noise can arise from instructional voices and environmental sounds in places such as a battlefield and industrial and high-traffic areas. A feedback device using a flashing light was designed to overcome noise-induced stimulus saturation during CPR. This study was conducted to determine whether 'flashlight' guidance influences CPR performance in a simulated noisy setting. We recruited 30 senior medical students with no previous experience of using flashlight-guided CPR to participate in this prospective, simulation-based, crossover study. The experiment was conducted in a simulated noisy situation using a cardiac arrest model without ventilation. Noise such as patrol car and fire engine sirens was artificially generated. The flashlight guidance device emitted light pulses at the rate of 100 flashes/min. Participants also received instructions to achieve the desired rate of 100 compressions/min. CPR performances were recorded with a Resusci Anne mannequin with a computer skill-reporting system. There were significant differences between the control and flashlight groups in mean compression rate (MCR), MCR/min and visual analogue scale. However, there were no significant differences in correct compression depth, mean compression depth, correct hand position, and correctly released compression. The flashlight group constantly maintained the pace at the desired 100 compressions/min. Furthermore, the flashlight group had a tendency to keep the MCR constant, whereas the control group had a tendency to decrease it after 60 s. Flashlight-guided CPR is particularly advantageous for maintaining a desired MCR during hands-only CPR in noisy environments, where metronome pacing might not be clearly heard.

  18. Chest compression with kneeling posture in hospital cardiopulmonary resuscitation: A randomised crossover simulation study.

    Science.gov (United States)

    Oh, Jaehoon; Chee, Youngjoon; Lim, Taeho; Cho, Youngsuk; Kim, In Young

    2014-12-01

    We suggest an alternative chest compression (CC) in kneeling posture using a 'kneeling stool' on which the performer kneels beside the patient on a bed in-hospital. In kneeling posture, we can maintain high quality cardiopulmonary resuscitation (CPR) without the bed height adjustment, which is necessary and inconvenient in standing posture. This study is a randomised crossover trial with 38 participants working in one ED. The first group knelt on the kneeling stool beside a manikin placed on a bed, whereas the second group stood on a step stool with the manikin at knee level using bed height adjustment. All the participants performed continuous chest compression for 5 min without audio-visual feedback. After that, the posture was changed in each group. The parameters of CC quality (CC depth, rate, accuracy, and incomplete chest recoil), visual analogue scale (VAS) for fatigue and pain, and preference of participants were compared between the two groups. The data of 33 participants in both postures were analysed following exclusion of five participants. In the comparisons overall and per minute between the two postures, the parameters and VAS do not differ significantly (all P > 0.05) except for the median 1st CC rate that was faster in kneeling posture than in standing posture, P = 0.01). Twenty-three performers preferred the kneeling posture. A kneeling posture with a kneeling stool were preferred by participants, which have shown similar results in CC parameters and VAS with a standing posture on a stepstool with bed height adjustment during in-hospital CPR. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation.

    Science.gov (United States)

    Binder, Corinna; Schmölzer, Georg M; O'Reilly, Megan; Schwaberger, Bernhard; Urlesberger, Berndt; Pichler, Gerhard

    2014-03-01

    To investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR). In this observational study, 32 participants delivered positive pressure ventilation (PPV) to a modified, leak-free manikin via facemask. Mask leak, tidal volume (VT), positive end expiratory pressure (PEEP) and respiratory rate (RR) were measured with a respiratory function monitor (RFM). Participants had to perform four studies. In the first study, participants performed PPV alone as baseline. Thereafter, three studies were performed in random order. In the PPV+ECC+manometer group, participants had to observe the manometer while the RFM was covered; in the PPV+ECC+RFM group, the RFM was used while the manometer was covered; and in the PPV+ECC+verbal feedback group, the RFM and manometer were covered while a team leader viewed the RFM and provided verbal feedback to the participants. Median (IQR) mask leak of all studies was 15% (5-47%). Comparing the studies, PPV+ECC+RFM and PPV+ECC+verbal feedback had significantly less mask leak than PPV+ECC+manometer. Mean (SD) VT of all studies was 9.5±3.5 mL. Comparing all studies, PPV+ECC+RFM had a significantly higher VT than PPV and PPV+ECC+manometer. As well, PPV+ECC+verbal feedback had a significantly higher VT than PPV. PEEP and RR were within our target, mean (SD) PEEP was 6±2 cmH2O and RR was 36±13/min. During simulated neonatal CPR, ECCs did not influence mask leak, and a RFM and verbal feedback were helpful methods to reduce mask leak and increase VT significantly.

  20. Emergency care staff experiences of lay presence during adult cardiopulmonary resuscitation: a phenomenological study.

    Science.gov (United States)

    Walker, Wendy Marina

    2014-06-01

    Public support in favour of family presence during an adult cardiopulmonary resuscitation (CPR) attempt is a contentious issue among providers of emergency care. Researchers have mostly relied on attitudinal surveys to elicit staff views, leaving the life-world of those who have experienced this phenomenon, largely unexplored. To explore the lived experience of lay presence during an adult CPR attempt in primary (out-of-hospital) and secondary (inhospital) environments of care. Hermeneutical phenomenological study. Semistructured, face-to-face interviews with 8 ambulance staff and 12 registered nurses. The interviews were audio-recorded and subjected to thematic analysis. Participants provided insight into situations where lay presence during adult CPR came about either spontaneously or as a planned event. Their accounts portrayed a mixture of benefits and concerns. Familiarity of working in the presence of lay people, practical experience in emergency care and personal confidence were important antecedents. Divergent practices within and across the contexts of care were revealed. The concept of exposure emerged as the essence of this phenomenon. Overall, the study findings serve to challenge some of the previously reported attitudes and opinions of emergency care staff. Improved intraprofessional and interprofessional collaboration is essential to overcoming the barriers associated with lay presence during adult CPR. The future of this practice is dependent on initiatives that seek to bring about attitudinal change. Priority should be given to further exploring this phenomenon in the context of patient and family centred end-of-life care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Effect of epinephrine on cerebral and myocardial perfusion in an infant animal preparation of cardiopulmonary resuscitation.

    Science.gov (United States)

    Schleien, C L; Dean, J M; Koehler, R C; Michael, J R; Chantarojanasiri, T; Traystman, R; Rogers, M C

    1986-04-01

    We assessed the efficacy of conventional cardiopulmonary resuscitation (CPR) in 2-week-old piglets. We determined intrathoracic vascular pressures, cerebral (CBF) and myocardial blood flows (MBF), and cerebral oxygen uptake during conventional CPR in this infant animal preparation and contrasted these results with those of previous work on adult animals. We further examined the effects of the infusion of epinephrine on these pressures and flows and on cerebral oxygen uptake, which has not been previously evaluated in adult preparations. Conventional CPR was performed on pentobarbital-anesthetized piglets with a 20% sternal displacement with the use of a pneumatic piston compressor. Chest recoil was incomplete, leading to an 18% to 27% reduction in anteroposterior diameter during the relaxation phase. Aortic and right atrial pressures in excess of 80 mm Hg were generated. These pressures are greater than those generally obtained in adult animals with similar percent pulsatile displacements. CBF and MBF were also initially greater than those reported in adult animals undergoing conventional CPR. However, when CPR was prolonged beyond 20 min, aortic pressure fell and CBF and MBF declined to the near-zero levels seen in adult preparations. At 5 min of CPR, CBF and MBF were 24 +/- 7 and 27 +/- 7 ml . min-1 x 100 g-1 (50% and 17% of the values during cardiac arrest), respectively. With the continuous infusion of epinephrine (4 micrograms/kg/min) in another group of animals, MBF was significantly greater at 20 min of CPR and CBF and cerebral O2 uptake were greater at 35 min of CPR as a result of higher perfusion pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Reliability and accuracy of the thoracic impedance signal for measuring cardiopulmonary resuscitation quality metrics.

    Science.gov (United States)

    Alonso, Erik; Ruiz, Jesús; Aramendi, Elisabete; González-Otero, Digna; Ruiz de Gauna, Sofía; Ayala, Unai; Russell, James K; Daya, Mohamud

    2015-03-01

    To determine the accuracy and reliability of the thoracic impedance (TI) signal to assess cardiopulmonary resuscitation (CPR) quality metrics. A dataset of 63 out-of-hospital cardiac arrest episodes containing the compression depth (CD), capnography and TI signals was used. We developed a chest compression (CC) and ventilation detector based on the TI signal. TI shows fluctuations due to CCs and ventilations. A decision algorithm classified the local maxima as CCs or ventilations. Seven CPR quality metrics were computed: mean CC-rate, fraction of minutes with inadequate CC-rate, chest compression fraction, mean ventilation rate, fraction of minutes with hyperventilation, instantaneous CC-rate and instantaneous ventilation rate. The CD and capnography signals were accepted as the gold standard for CC and ventilation detection respectively. The accuracy of the detector was evaluated in terms of sensitivity and positive predictive value (PPV). Distributions for each metric computed from the TI and from the gold standard were calculated and tested for normality using one sample Kolmogorov-Smirnov test. For normal and not normal distributions, two sample t-test and Mann-Whitney U test respectively were applied to test for equal means and medians respectively. Bland-Altman plots were represented for each metric to analyze the level of agreement between values obtained from the TI and gold standard. The CC/ventilation detector had a median sensitivity/PPV of 97.2%/97.7% for CCs and 92.2%/81.0% for ventilations respectively. Distributions for all the metrics showed equal means or medians, and agreements >95% between metrics and gold standard was achieved for most of the episodes in the test set, except for the instantaneous ventilation rate. With our data, the TI can be reliably used to measure all the CPR quality metrics proposed in this study, except for the instantaneous ventilation rate. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis

    2018-06-01

    To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

  4. Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs.

    Science.gov (United States)

    Pytte, Morten; Kramer-Johansen, Jo; Eilevstjønn, Joar; Eriksen, Morten; Strømme, Taevje A; Godang, Kristin; Wik, Lars; Steen, Petter Andreas; Sunde, Kjetil

    2006-12-01

    Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis. After 4 min of cardiac arrest, followed by 4 min of basic life support, 14 pigs were randomised to ClinicalCPR (intermittent manual chest compressions, compression-to-ventilation ratio 15:2, compression depth 30-38 mm) or LabCPR (continuous mechanical chest compressions, 12 ventilations/min, compression depth 45 mm). Adrenaline 0.02 mg/kg was administered 30 s thereafter. Plasma adrenaline concentration peaked earlier with LabCPR than with ClinicalCPR, median (range), 90 (30, 150) versus 150 (90, 270) s (p = 0.007), respectively. Coronary perfusion pressure (CPP) and cortical cerebral blood flow (CCBF) increased and femoral blood flow (FBF) decreased after adrenaline during LabCPR (mean differences (95% CI) CPP 17 (6, 29) mmHg (p = 0.01), FBF -5.0 (-8.8, -1.2) ml min(-1) (p = 0.02) and median difference CCBF 12% of baseline (p = 0.04)). There were no significant effects during ClinicalCPR (mean differences (95% CI) CPP 4.7 (-3.2, 13) mmHg (p = 0.2), FBF -0.2 (-4.6, 4.2) ml min(-1)(p = 0.9) and CCBF 3.6 (-1.8, 9.0)% of baseline (p = 0.15)). Slope VF waveform analysis reflected changes in CPP. Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.

  5. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

  6. Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

    Science.gov (United States)

    Krage, Ralf; Zwaan, Laura; Tjon Soei Len, Lian; Kolenbrander, Mark W; van Groeningen, Dick; Loer, Stephan A; Wagner, Cordula; Schober, Patrick

    2017-11-01

    Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present. In this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the 'Anaesthetists' Non-technical Skill' score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses. Non-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, ptechnical performance score (task management, team working, situation awareness, decision-making). During CPR with external stressors, the team's technical performance is related to the non-technical skills of the team leader. This may have important implications for training of

  7. The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Hansen, Lars Koch; Mohammed, Anna; Pedersen, Magnus

    2016-01-01

    INTRODUCTION: Reducing hands-off time during cardiopulmonary resuscitation (CPR) is believed to increase survival after cardiac arrests because of the sustaining of organ perfusion. The aim of our study was to investigate whether charging the defibrillator before rhythm analyses and shock delivery...... significantly reduced hands-off time compared with the European Resuscitation Council (ERC) 2010 CPR guideline algorithm in full-scale cardiac arrest scenarios. METHODS: The study was designed as a full-scale cardiac arrest simulation study including administration of drugs. Participants were randomized...... compressions. RESULTS: Sample size was calculated with an α of 0.05 and 80% power showed that we should test four scenarios with each algorithm. Twenty-nine physicians participated in 11 scenarios. Hands-off time was significantly reduced 17% using the SOWS algorithm compared with ERC2010 [22.1% (SD 2.3) hands...

  8. Comparison of Bystander Cardiopulmonary Resuscitation (BCPR) Performance in the Absence and Presence of Timing Devices for Coordinating Delivery of Ventilatory Breaths and Cardiac Compressions in a Model of Adult Cardiopulmonary Arrest

    Science.gov (United States)

    Hurst, Victor, IV; West, Sarah; Austin, Paul; Branson, Richard; Beck, George

    2006-01-01

    Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training during the 18 months preceding each mission. Part of this training ilncludes twoperson cardiopulmonary resuscitation (CPR) per training guidelines from the American Heart Association (AHA). Recent studies concluded that the use of metronomic tones improves the coordination of CPR by trained clinicians. Similar data for bystander or "trained lay people" (e.g. CMO) performance of CPR (BCPR) have been limited. The purpose of this study was to evailuate whether use of timing devices, such as audible metronomic tones, would improve BCPR perfomance by trained bystanders. Twenty pairs of bystanders trained in two-person BCPR performled BCPR for 4 minutes on a simulated cardiopulmonary arrest patient using three interventions: 1) BCPR with no timing devices, 2) BCPR plus metronomic tones for coordinating compression rate only, 3) BCPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Bystanders were evaluated on their ability to meet international and AHA CPR guidelines. Bystanders failed to provide the recommended number of breaths and number of compressions in the absence of a timing device and in the presence of audible metronomic tones for only coordinating compression rate. Bystanders using timing devices to coordinate both components of BCPR provided the reco number of breaths and were closer to providing the recommended number of compressions compared with the other interventions. Survey results indicated that bystanders preferred to use a metronome for delivery of compressions during BCPR. BCPR performance is improved by timing devices that coordinate both compressions and breaths.

  9. [Motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation technique: recommendations for the teaching-learning process].

    Science.gov (United States)

    Miyadahira, A M

    2001-12-01

    It is a bibliographic study about the identification of the motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation (CPR) which aims to obtain subsidies to the planning of the teaching-learning process of this skill. It was found that: the motor capacities involved in the psychomotor skill of the CPR technique are predominantly cognitive and motor, involving 9 perceptive-motor capacities and 8 physical proficiency capacities. The CPR technique is a psychomotor skill classified as open, done in series and categorized as a thin and global skill and the teaching-learning process of the CPR technique has an elevated degree of complexity.

  10. Comparison of training in neonatal resuscitation using self inflating bag and T-piece resuscitator

    Science.gov (United States)

    Mathai, S.S.; Adhikari, K.M.; Rajeev, A.

    2014-01-01

    Background Both the self inflating bag and the T-piece resuscitator are recommended for neonatal resuscitation, but many health care workers are unfamiliar with using the latter. A prospective, comparative, observational study was done to determine the ease and effectiveness of training of health care personnel in the two devices using infant training manikins. Methods 100 health care workers, who had no prior formal training in neonatal resuscitation, were divided into small groups and trained in the use of the two devices by qualified trainers. Assessment of cognitive skills was done by pre and post MCQs. Psychomotor skill was assessed post training on manikins using a 10-point objective score. Acceptance by users was ascertained by questionnaire. Assessments were also done after 24 h and 3 months. Comparison was done by Chi square and paired t-tests. Results Pre-training cognitive tests increased from 3.77 (+1.58) to 6.99 (+1.28) on day of training which was significant. Post training assessment of psychomotor skills showed significantly higher initial scores for the T-piece group (7.07 + 2.57) on day of training. Reassessment after 24 h showed significant improvement in cognitive scores (9.89 + 1.24) and psychomotor scores in both groups (8.86 + 1.42 for self inflating bag and 9.70 + 0.57 for T-piece resuscitator). After 3–6 months the scores in both domains showed some decline which was not statistically significant. User acceptability was the same for both devices. Conclusion It is equally easy to train health care workers in both devices. Both groups showed good short term recall and both devices were equally acceptable to the users. PMID:25609858

  11. [New standards for catecholamine therapy in cardiopulmonary resuscitation? Results of a modified application in a resuscitation model].

    Science.gov (United States)

    Hörnchen, U; Lussi, C; Schüttler, J

    1992-06-01

    Using a standardized porcine CPR-model (3 min of cardiac arrest induced by ventricular fibrillation) the effects of epinephrine (10 micrograms/kg iv, 50 micrograms/kg iv, 100 micrograms/kg endobronchially, eb) and norepinephrine (10 micrograms/kg iv, 100 micrograms/kg eb) on resuscitability and early post-resuscitation haemodynamics were compared. Success rate was 100% after epinephrine 10 micrograms/kg iv and 100 micrograms/kg eb, 75% after epinephrine 50 micrograms/kg iv, 80% after norepinephrine iv and 60% after norepinephrine eb. In an unmedicated control group 50% of all animals were successfully resuscitated. Early post-resuscitation haemodynamics in the high dose epinephrine group were characterized by tachycardia and progredient myocardial failure, while in the norepinephrine groups a low cardiac output was accompanied by small cardiac stroke volumes and an increased vascular resistance. It is concluded that iv or eb epinephrine given in standard doses has still to be considered as the drug therapy of choice after short term cardiac arrest or in the presence of ventricular fibrillation. Before different drugs or dosing strategies can be recommended, further experimental and clinical validation is required.

  12. National neonatal resuscitation training program in Nigeria (2008 ...

    African Journals Online (AJOL)

    2014-08-05

    Aug 5, 2014 ... Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. Results: Over the period of study, ... and retrain all birth attendants. A recent systematic review .... on the registration list for that year on mobile telephone, making attempts at different ...

  13. The Effect of Instructional Method on Cardiopulmonary Resuscitation Skill Performance: A Comparison Between Instructor-Led Basic Life Support and Computer-Based Basic Life Support With Voice-Activated Manikin.

    Science.gov (United States)

    Wilson-Sands, Cathy; Brahn, Pamela; Graves, Kristal

    2015-01-01

    Validating participants' ability to correctly perform cardiopulmonary resuscitation (CPR) skills during basic life support courses can be a challenge for nursing professional development specialists. This study compares two methods of basic life support training, instructor-led and computer-based learning with voice-activated manikins, to identify if one method is more effective for performance of CPR skills. The findings suggest that a computer-based learning course with voice-activated manikins is a more effective method of training for improved CPR performance.

  14. Design of a Functional Training Prototype for Neonatal Resuscitation

    Directory of Open Access Journals (Sweden)

    Sivaramakrishnan Rajaraman

    2014-11-01

    Full Text Available Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD and Light Emitting Diode (LED indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings.

  15. Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival.

    Science.gov (United States)

    Berg, Robert A; Sutton, Robert M; Reeder, Ron W; Berger, John T; Newth, Christopher J; Carcillo, Joseph A; McQuillen, Patrick S; Meert, Kathleen L; Yates, Andrew R; Harrison, Rick E; Moler, Frank W; Pollack, Murray M; Carpenter, Todd C; Wessel, David L; Jenkins, Tammara L; Notterman, Daniel A; Holubkov, Richard; Tamburro, Robert F; Dean, J Michael; Nadkarni, Vinay M

    2017-12-26

    Background -Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, American Heart Association recommends using BP to guide pediatric CPR. However, evidence-based BP targets during pediatric CPR remain an important knowledge gap for CPR guidelines. Methods -All children ≥37 weeks gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mmHg during CPR in infants and ≥30 mmHg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurologic outcome, defined as Pediatric Cerebral Performance Categories 1-3 or no worse than pre-arrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes. Results -Blinded investigators analyzed BP waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% post-cardiac surgery. Immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes [quartiles: 3 minutes, 27 minutes]. Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge and 43% survived to discharge with favorable neurologic outcome. Maintaining mean DBP ≥25 mmHg in infants and ≥30 mmHg in children ≥1 year old occurred in 101/164 children (62%) and

  16. Effects of kneeling posture on chest compression during cardiopulmonary resuscitation in males.

    Science.gov (United States)

    Ho, Michael Sh; Chow, Daniel Hk

    2018-02-01

    To study the effects of kneeling posture on chest compression during cardiopulmonary resuscitation (CPR) in males. Efficiency of chest compression during CPR affected millions of victims over the world. There are still no clear guidelines on kneeling posture that a rescuer should adopt in performing CPR. A self-controlled repeated-measures design was applied in this study. The efficiency of chest compression on a mannequin when three kneeling postures were adopted (farthest, self-adjusted and nearest) was analysed. Eighteen participants with qualified first-aid certificate were recruited. Each participant had to perform three sessions of CPR, using one of the three different kneeling postures (i.e., farthest, self-adjusted and nearest) in each. They were performed in a random order chosen by drawing lots. Each session consisted of five cycles of CPR in each kneeling posture. Each cycle consisted of 30 strokes of chest compression performed within 18 s with a 4-s pause between consecutive cycles. Each session lasted for 2 min. The participants were allowed to rest for 10 min on a chair between sessions. Efficiency of chest compression was quantified by compression force, joint angle, heart rate and energy expenditure. After each session of CPR, the participants were surveyed about their rate of perceived exertion. Efficiency of chest compression in self-adjusted and nearest kneeling postures was significantly better than that of the farthest one. While the self-adjusted and nearest postures had the similar effect, most of the participants preferred self-adjusted kneeling posture because of lower rate of perceived exertion. The use of the self-adjusted and nearest kneeling postures during CPR in males resulted in more effective chest compression with lower perceived exertion, compared with the farthest kneeling posture. Both these positions can be objectively recommended to enhance the efficiency of chest compression and thereby increase the cardiac arrest

  17. Cardiopulmonary stress during exercise training in patients with COPD.

    Science.gov (United States)

    Probst, V S; Troosters, T; Pitta, F; Decramer, M; Gosselink, R

    2006-06-01

    Exercise training is an essential component of pulmonary rehabilitation. However, the cardiopulmonary stress imposed during different modalities of exercise training is not yet known. In the present study, the cardiopulmonary stress of a 12-week exercise training programme in 11 chronic obstructive pulmonary disease (COPD) patients (forced expiratory volume in one second 42+/-12%pred, age 69+/-6 yrs) was measured. Pulmonary gas exchange and cardiac frequency (f(C)) of three training sessions were measured with a portable metabolic system at the beginning, mid-term and end of the programme. Symptoms were assessed with Borg scores. The exercise intensity was compared with the recommendations for exercise training by the American College of Sports Medicine (ACSM). Training effects were significant (maximum change in work: 14+/-11 Watts, 6-min walk test: 44+/-36 m). Whole body exercises (cycling, walking and stair climbing) consistently resulted in higher cardiopulmonary stress (oxygen uptake (V'(O(2))), minute ventilation and f(C)) than arm cranking and resistance training. Dyspnoea was higher during cycling than resistance training. Patients exercised for >70% (>20 min) of the total exercise time at >40% of the V'(O(2)) reserve and f(C) reserve ("moderate" intensity according to the ACSM) throughout the programme. The cardiopulmonary stress resistance training is lower than during whole-body exercise and results in fewer symptoms. In addition, exercise testing based on guidelines using a fixed percentage of baseline peak performance and symptom scores achieves and sustains training intensities recommended according to the American College of Sports Medicine.

  18. Changes in adherence to cardiopulmonary resuscitation guidelines in a single referral center from January 2009 to June 2013 and assessment of factors contributing to the observed changes.

    Science.gov (United States)

    Holmes, Andrea C; Clark, Louise

    2015-01-01

    This retrospective study reviewed compliance to cardiopulmonary resuscitation (CPR) teaching at a small animal referral center from January 2009 to June 2013. CPR training commenced in October 2009. This was a lecture format by European specialists in veterinary anesthesia and analgesia. Teaching was originally based on published guidelines. Changes made to the content of the lectures after publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012 are discussed. Data regarding basic life support and monitoring equipment were collected from all cases requiring CPR. A Mann-Kendall test for trend showed a significant increased use of both capnography (P = 0.017) and suction to aid tracheal intubation (P = 0.017) over the period of study. There was a significant increase in capnography use in 2011 (P = 0.046), 2012 (P = 0.002), and 2013 (P = 0.002) compared to 2009 (1/15). The sequential increase in capnography use without any change to the number or availability of capnography units provides evidence that CPR teaching has altered clinical practice. The publication of the RECOVER guidelines provided an evidence base upon which to refine and improve teaching of CPR. © Veterinary Emergency and Critical Care Society 2015.

  19. Jordanian professional nurses' attitudes and experiences of having family members present during cardiopulmonary resuscitation of adult patients.

    Science.gov (United States)

    Hayajneh, Ferial A

    2013-01-01

    The presence of family members during cardiopulmonary resuscitation (CPR) of an adult patient remains a contentious area of practice that has attracted wide international debate. However, the attitude and experience of Jordanian nurses concerning this area of practice are not known yet. This descriptive quantitative study was aimed at identifying the attitudes and experiences of Jordanian nurses toward the presence of family members during CPR of adult patients. A questionnaire that was developed by Fulbrook et al was completed by 136 nurses. There were 91.9% (n = 125) nurses who did not have any experience or a protocol or policy document on family presence during CPR and 97.7% (n = 133) nurses stated that they did not have any experience of inviting a family member to be present during CPR. Also, the result of this study revealed that Jordanian nurses had negative attitudes toward the presence of family members during CPR of an adult patient. Before initiating hospital policy regarding the option of family presence during resuscitation, attitudes and experiences of patients and relatives on witnessed resuscitation should be explored. Also, educating nurses about the importance of practicing to have the presence of family members during CPR of adult patients should be considered.

  20. The effects of changes to the ERC resuscitation guidelines on no flow time and cardiopulmonary resuscitation quality: a randomised controlled study on manikins.

    Science.gov (United States)

    Jäntti, H; Kuisma, M; Uusaro, A

    2007-11-01

    The European Resuscitation Council (ERC) guidelines changed in 2005. We investigated the impact of these changes on no flow time and on the quality of cardiopulmonary resuscitation (CPR). Simulated cardiac arrest (CA) scenarios were managed randomly in manikins using ERC 2000 or 2005 guidelines. Pairs of paramedics/paramedic students treated 34 scenarios with 10min of continuous ventricular fibrillation. The rhythm was analysed and defibrillation shocks were delivered with a semi-automatic defibrillator, and breathing was assisted with a bag-valve-mask; no intravenous medication was given. Time factors related to human intervention and time factors related to device, rhythm analysis, charging and defibrillation were analysed for their contribution to no flow time (time without chest compression). Chest compression quality was also analysed. No flow time (mean+/-S.D.) was 66+/-3% of CA time with ERC 2000 and 32+/-4% with ERC 2005 guidelines (PERC 2000) versus 107+/-4s (ERC 2005) during 600-s scenarios (P=0.237). Device factor interventions took longer using ERC 2000 guidelines: 290+/-19s versus 92+/-15s (PERC 2005 guidelines (808+/-92s versus 458+/-90s, P<0.001), but the quality of CPR did not differ between the groups. The use of a single shock sequence with guidelines 2005 has decreased the no flow time during CPR when compared with guidelines 2000 with multiple shocks.

  1. Correlation between quality of cardiopulmonary resuscitation and self-efficacy measured during in-hospital cardiac arrest simulation; preliminary results.

    Science.gov (United States)

    Gonzi, Gianluca; Sestigiani, Fiorella; D'errico, Antonella; Vezzani, Antonella; Bonfanti, Laura; Noto, Giancarlo; Artioli, Giovanna

    2015-03-13

    The concept of self-assess it's a central mechanism in human agency for behavior change and should translate to desirable practice patterns. There are no many studies that have investigated the relationship between the perception of the ability to perform cardiopulmonary resuscitation (CPR) and the quality of the same. The aim of this work is to investigate the relation between physiological and psychosocial variables in cardiac resuscitation in order to improve the involvement and motivation of professionals in training courses. During the year 2012, 322 medical staff of Ospedale-Universitario of Parma were trained to basic life support defibrillation (BLSD). Before started the course the partecipants were randomly selected among the staff working in the same department to create a team of two persons and involved in a simulation that reproduced the first five minutes that occurs for a cardiac arrest in a medical or surgical department in our hospital before the intervention of the hospital emergency team. Before and after simulation to each participant was asked to answer a self-efficacy questionnaire on a 10-point scale on the management of cardiac. During simulation were registered the activation time of the emergency response system, hands-on time, defibrillation time, number of compression and correct compression rate. Activation time of the emergency response system was 70.52 ± 78.77 seconds. In 55 teams was not made the allert. The defibrillation time was 148.63 ± 58.43 seconds. In 44 teams the defibrillator were used within 120 seconds, in 36 (22.1%) it was not used. Hands-on time average was of 166.20 ± 62.9 seconds. The mean number of compression was 216.22 ± 115.57. The percentage of satisfactory compression was 9.97 ± 21.23 %. The level of self-efficacy was under the average for the 35.6%, while the 26.8% of the participants had a medium level of 5 and the 38.5% of the sample declared to feel an efficacy level included in 6-10. The sense of self

  2. Systematic review and meta-analysis of hemodynamic-directed feedback during cardiopulmonary resuscitation in cardiac arrest.

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    Chopra, A S; Wong, N; Ziegler, C P; Morrison, L J

    2016-04-01

    Physiologic monitoring of resuscitative efforts during cardiac arrest is gaining in importance, as it provides a real-time window into the cellular physiology of patients. The aim of this review is to assess the quality of evidence surrounding the use of physiologic monitoring to guide cardiopulmonary resuscitation (CPR), and to examine whether the evidence demonstrates an improvement in patient outcome when comparing hemodynamic-directed CPR versus standard CPR. Studies were obtained through a search of the PubMed, Embase and Cochrane databases. Peer-reviewed randomized trials, case-control studies, systematic reviews, and cohort studies that titrated CPR to physiologic measures, compared results to standard CPR, and examined patient outcome were included. Six studies met inclusion criteria, with all studies conducted in animal populations. Four studies examined the effects of hemodynamic-directed CPR on survival, with 35/37 (94.6%) animals surviving in the hemodynamic-directed CPR groups and 12/35 (34.3%) surviving in the control groups (pCPR on ROSC, with 22/30 (73.3%) achieving ROSC in the hemodynamic-directed CPR group and 19/30 (63.3%) achieving ROSC in the control group (p=0.344). These results suggest a trend in survival from hemodynamic-directed CPR over standard CPR, however the small sample size and lack of human data make these results of limited value. Future human studies examining hemodynamic-directed CPR versus current CPR standards are needed to enhance our understanding of how to effectively use physiologic measures to improve resuscitation efforts and ultimately incorporate concrete targets into international resuscitation guidelines. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Therapeutic hypothermia activates the endothelin and nitric oxide systems after cardiac arrest in a pig model of cardiopulmonary resuscitation.

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    Frank Zoerner

    Full Text Available Post-cardiac arrest myocardial dysfunction is a major cause of mortality in patients receiving successful cardiopulmonary resuscitation (CPR. Mild therapeutic hypothermia (MTH is the recommended treatment after resuscitation from cardiac arrest (CA and is known to exert neuroprotective effects and improve short-term survival. Yet its cytoprotective mechanisms are not fully understood. In this study, our aim was to determine the possible effect of MTH on vasoactive mediators belonging to the endothelin/nitric oxide axis in our porcine model of CA and CPR. Pigs underwent either untreated CA or CA with subsequent CPR. After state-of-the-art resuscitation, the animals were either left untreated, cooled between 32-34 °C after ROSC or treated with a bolus injection of S-PBN (sodium 4-[(tert-butylimino methyl]benzene-3-sulfonate N-oxide until 180 min after ROSC, respectively. The expression of endothelin 1 (ET-1, endothelin converting enzyme 1 (ECE-1, and endothelin A and B receptors (ETAR and ETBR transcripts were measured using quantitative real-time PCR while protein levels for the ETAR, ETBR and nitric oxide synthases (NOS were assessed using immunohistochemistry and Western Blot. Our results indicated that the endothelin system was not upregulated at 30, 60 and 180 min after ROSC in untreated postcardiac arrest syndrome. Post-resuscitative 3 hour-long treatments either with MTH or S-PBN stimulated ET-1, ECE-1, ETAR and ETBR as well as neuronal NOS and endothelial NOS in left ventricular cardiomyocytes. Our data suggests that the endothelin and nitric oxide pathways are activated by MTH in the heart.

  4. Effect of one-rescuer compression/ventilation ratios on cardiopulmonary resuscitation in infant, pediatric, and adult manikins.

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    Srikantan, Shoba Krishnan; Berg, Robert A; Cox, Tim; Tice, Lisa; Nadkarni, Vinay M

    2005-05-01

    Optimal chest compression to ventilation ratio (C:V) for one-rescuer cardiopulmonary resuscitation (CPR) is not known, with current American Heart Association recommendations 3:1 for newborns, 5:1 for children, and 15:2 for adults. C:V ratios influence effectiveness of CPR, but memorizing different ratios is educationally cumbersome. We hypothesized that a 10:2 ratio might provide adequate universal application for all age arrest victims. Clinical study. Tertiary care children's hospital. Thirty-five health care providers. Thirty-five health care providers performed 5-min epochs of one-rescuer CPR at C:V ratios of 3:1, 5:1, 10:2, and 15:2 in random order on infant, pediatric, and adult manikins. Compressions were paced at 100/min by metronome. The number of effective compressions and ventilations delivered per minute was recorded by a trained basic life support instructor. Subjective assessments of fatigue (self-report) and exertion (change in rescuer pulse rate compared with baseline) were assessed. Analysis was by repeated measures analysis of variance and paired Student's t-test. Effective infant compressions per minute did not differ by C:V ratio, but ventilations per minute were greater at 3:1 vs. 5:1, 10:2, and 15:2 (p 15:2 (p CPR (p metronome-paced, one-rescuer CPR. Low ratios of 3:1, 5:1, and 10:2 favor ventilation, and high ratios of 15:2 favor compression, especially in adult manikins. Rescuers subjectively preferred C:V ratios of 10:2 and 15:2 over 3:1 or 5:1. Infant CPR caused less exertion and subjective fatigue than pediatric or adult CPR technique, without significant difference by C:V ratio. We speculate that a universal 10:2 C:V ratio for one-rescuer layperson CPR is physiologically reasonable but warrants further study with particular attention to educational value and technique retention.

  5. The Impact of Monitoring on the Initiation of Cardiopulmonary Resuscitation in Children: Friend or Foe?

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    Hörner, Elisabeth; Schebesta, Karl; Hüpfl, Michael; Kimberger, Oliver; Rössler, Bernhard

    2016-02-01

    The immediate initiation and high quality of basic life support (BLS) are pivotal to improving patient outcome after cardiac arrest. Although cardiorespiratory monitoring could shorten the time to recognize the onset of cardiac arrest, little is known about how monitoring and the misinterpretation of monitor readings could impair the initiation of BLS. In this study, we assessed the speed of initiation and quality of BLS in simulated monitored and nonmonitored pediatric cardiac arrest. Sixty residents frequently involved in the care of critically ill children were randomly assigned to either the intervention (monitoring) group or the control (nonmonitoring) group. Participants of both groups performed BLS in 1 of 2 clinically identical, unwitnessed simulated cardiac arrest scenarios. Although in 1 scenario cardiorespiratory monitoring (i.e., electrocardiogram) was attached, the other scenario reflected a nonmonitored cardiac arrest. Time to first chest compression was chosen as the primary outcome variable. Adherence to resuscitation guidelines and subjective performance ratings were secondary outcome variables. Participants in the monitoring group initiated chest compressions significantly later than those in the nonmonitoring group (91 ± 36 vs 71 ± 26 seconds, hazard ratio, 0.26; 95% confidence interval, 0.14-0.49, P compression within 5 minutes. Furthermore, adherence to the guidelines was better in the nonmonitoring group. Participants who were previously involved in BLS training did not show better performance. The presence of cardiorespiratory monitoring significantly delayed or even prevented the initiation of chest compressions and impaired the quality of BLS in simulated pediatric cardiac arrest. Based on these data, specific training should be conducted for exposed personnel.

  6. Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest.

    Science.gov (United States)

    Huang, Yu; He, Qing; Yang, Li J; Liu, Guan J; Jones, Alexander

    2014-09-12

    Sudden cardiac arrest (SCA) is a common health problem associated with high levels of mortality. Cardiac arrest is caused by three groups of dysrhythmias: ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), pulseless electric activity (PEA) and asystole. The most common dysrhythmia found in out-of-hospital cardiac arrest (OHCA) is VF. During VF or VT, cardiopulmonary resuscitation (CPR) provides perfusion and oxygenation to the tissues, whilst defibrillation restores a viable cardiac rhythm. Early successful defibrillation is known to improve outcomes in VF/VT. However, it has been hypothesized that a period of CPR before defibrillation creates a more conducive physiological environment, increasing the likelihood of successful defibrillation. The order of priority of CPR versus defibrillation therefore remains in contention. As previous studies have remained inconclusive, we conducted a systematic review of available evidence in an attempt to draw conclusions on whether CPR plus delayed defibrillation or immediate defibrillation resulted in better outcomes in OHCA. To examine whether an initial one and one-half to three minutes of CPR administered by paramedics before defibrillation versus immediate defibrillation on arrival influenced survival rates, neurological outcomes or rates of return of spontaneous circulation (ROSC) in OHCA. We searched the following databases: the Cochrane Central Register of Controlled trials (CENTRAL) (2013, Issue 6); MEDLINE (Ovid) (1948 to May 2013); EMBASE (1980 to May 2013); the Institute for Scientific Information (ISI) Web of Science (1980 to May 2013) and the China Academic Journal Network Publishing Database (China National Knowledge Infrastructure (CNKI), 1980 to May 2013). We included studies published in all languages. We also searched the Current Controlled Trials and Clinical Trials databases for ongoing trials. We screened the references lists of studies included in our review against the reference

  7. Efeito na Ressuscitação Cardiopulmonar utilizando treinamento teórico versus treinamento teórico-prático Efecto en la Resucitación Cardiopulmonar utilizando entrenamiento teórico versus entrenamiento teórico-prático Effects of the use of theoretical versus theoretical-practical training on Cardiopulmonary Resuscitation

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    Heberth César Miotto

    2010-09-01

    comparadas con 26 alumnos profesionales de la salud que participaron de un curso regular teórico-práctico de BLS-AHA (grupo B. Después de los cursos, los participantes fueron sometidos a evaluación teórica y práctica como es recomendado en los cursos del BLS-AHA. Las evaluaciones prácticas fueron grabadas y posteriormente puntuadas por tres instructores experimentados. La evaluación teórica fue un test de multiple choice usado en los cursos regulares del BLS-AHA. RESULTADOS: No hubo diferencia en la evaluación teórica (p = ns, mientras tanto la evaluación práctica fue consistentemente peor en el grupo A, evidenciado por los tres examinadores (p BACKGROUND: Theoretical knowledge and skill to perform good quality cardiopulmonary resuscitation (CPR are essential for the survival of patients with sudden death. OBJECTIVE: To determine whether a theoretical course alone is sufficient to promote good quality CPR training and knowledge for health professionals in comparison to a theoretical-practical basic life support training. METHODS: Twenty volunteer nurses participated in the theoretical CPR and automated external defibrillation (AED training by means of a theoretical class and video used in the Basic Life Support Training of the American Heart Association (BLS-AHA; group A. They were compared to other 26 health professionals who attended regular theoretical-practical BLS-AHA training (group B. After the training, the participants took theoretical and practical tests as recommended in BLS-AHA courses. The practical tests were recorded and were later scored by three experienced instructors. The theoretical test was a multiple choice test used in regular BLS-AHA courses. RESULTS: No difference was observed in the theoretical tests (p = ns. However, the practical tests were consistently worse in group A, as evaluated by the three examiners (p < 0.05. CONCLUSION: The use of CPR videos and theoretical training did not improve the individuals' psychomotor ability to

  8. Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service.

    Science.gov (United States)

    Sharma, Rupali; Jayathissa, Sisira; Weatherall, Mark

    2016-01-08

    To determine the knowledge in cardiopulmonary resuscitation (CPR) process, preference for CPR, and desire to participate in end-of-life decision making amongst older hospitalised patients. We prospectively interviewed 100 participants above 65 years of age awaiting discharge from acute medical ward and collected demographics, knowledge of CPR and opinion on CPR in various clinical scenarios. Amongst the participants, 58% had good understanding of all components of CPR and 91% overestimated its success. Fifty-eight percent wished to have CPR in current health status, but this declined if they were presented a hypothetical scenario of critical illness (46%), functional impairment (17%), terminal illness (13%) and dementia (13%). Tertiary education, male gender and not living alone were associated with accepting CPR. Ninety-three percent were comfortable discussing CPR and 84% felt comfortable documenting their wishes in the medical notes. Seventy percent wished such discussion to include themselves and their family. Older inpatients have a reasonable understanding of the components of CPR and wish to be involved in CPR decision-making. Clinical scenarios with poor prognosis may lead to patients declining CPR. Discussion and documentation of resuscitation wishes is useful in routine assessment process among elderly hospitalised patients.

  9. End-tidal CO2 Detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resuscitation Following Asystole in Asphyxiated Piglets

    Science.gov (United States)

    Chalak, Lina F.; Barber, Chad A.; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H.

    2011-01-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO2 (ETCO2) monitoring may provide a continuous non-invasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO2 value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO2 that is associated with ROSC following asphyxia-induced asystole. Neonatal swine (n=46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O2 followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 sec and ETCO2 was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO2 values where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO2 cut off value of 14 mmHg is the most sensitive ETCO2 value with the least false positives. When using ETCO2 to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO2 ≥14 mmHg is achieved. Correlation during human neonatal CPR needs further investigation. PMID:21283051

  10. End-tidal CO₂ detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets.

    Science.gov (United States)

    Chalak, Lina F; Barber, Chad A; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H

    2011-05-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO₂ (ETCO₂) monitoring may provide a continuous noninvasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO₂ value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO₂ that is associated with ROSC after asphyxia-induced asystole. Neonatal swine (n = 46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O₂ followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 s, and ETCO₂ was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO₂ values, where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO₂ cut-off value of 14 mm Hg is the most sensitive ETCO₂ value with the least false positives. When using ETCO₂ to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO₂ ≥ 14 mm Hg is achieved. Correlation during human neonatal CPR needs further investigation.

  11. Efficacy of Feed Forward and Feedback Signaling for Inflations and Chest Compression Pressure During Cardiopulmonary Resuscitation in a Newborn Mannequin

    Science.gov (United States)

    Andriessen, Peter; Oetomo, Sidarto Bambang; Chen, Wei; Feijs, Loe MG

    2012-01-01

    Background The objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED’s incorporated in the foil indicating the exerted force (feedback). Methods Ten pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly. Results The rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P CPR device compared to the controls. Conclusion Feed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR. PMID:22870175

  12. Can surf-lifeguards perform a quality cardiopulmonary resuscitation sailing on a lifeboat? A quasi-experimental study.

    Science.gov (United States)

    Barcala-Furelos, Roberto; Abelairas-Gomez, Cristian; Palacios-Aguilar, Jose; Rey, Ezequiel; Costas-Veiga, Javier; Lopez-Garcia, Sergio; Rodriguez-Nunez, Antonio

    2017-06-01

    Drowning is a high-priority public health problem around the world. The European Resuscitation Council Guidelines for Resuscitation 2015 put special emphasis on special environments like open waters. Stopping the drowning process as soon as possible and starting an early cardiopulmonary resuscitation (CPR) improve survival. Inflatable rescue boats (IRBs) are used around the world in the water rescue of drowning victims. Our objective was to test the quality of CPR performed by surf-lifeguards while sailing on an IRB. A quasi-experimental simulation trial was conducted in Tenerife (Canary Islands-Spain) on September 2015. Ten surf-lifeguards were asked to perform a 2 min CPR on manikins in four different scenarios: (1) onshore, (2) on adrift boat, (3) on a boat sailing at 5 knots and (4) on a boat sailing at 10 knots. CPR was performed individually and was measured by means of CPRmeter (Laerdal, Norway) located on the standard manikin. Repeated measures analysis of variance was used in order to analyse the differences between scenarios. The composite of all CPR variables was over 84% in all conditions, but it was lower when CPR was performed on board: onshore (96.49±3.58%) versus adrift (91.80±3.56, p=0.04), sailing at 5 knots (88.65±5.54, p=0.03) and sailing at 10 knots (84.74±5.56, p=0.001). Surf-lifeguards are able to deliver good-quality CPR even on a moving IRB, but their performance is lower than onshore. This fact should be considered in real cases to balance the risk and benefits of CPR on board. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Effects of sodium hydrosulfide on intestinal mucosal injury in a rat model of cardiac arrest and cardiopulmonary resuscitation.

    Science.gov (United States)

    Pan, Hao; Chen, Di; Liu, Beibei; Xie, Xuemeng; Zhang, Jincheng; Yang, Guangtian

    2013-07-19

    Cardiac arrest and cardiopulmonary resuscitation (CPR) can lead to intestinal ischemia/reperfusion (I/R) injury. Increasing studies have indicated that hydrogen sulfide (H2S) is in favor of a variety of tissue I/R injury. The purpose of this study was to explore whether sodium hydrosulfide (NaHS), a H2S donor, can protect intestinal mucosa after CPR and its potential mechanisms. Male Sprague-Dawley rats were subjected to 6min cardiac arrest induced by transcutaneous electrical epicardium stimulation and then resuscitated successfully. A bolus of either NaHS (0.5mg/kg) or placebo (NaCl 0.9%) was blindly injected 1min before the start of CPR intravenously, followed by a continuous injection of NaHS (2mg/kg/h) or placebo for 3h. Intestinal and plasma samples were collected for assessments 24h after CPR. We found that NaHS can markedly alleviate cardiac arrest induced intestinal mucosal injury. Rats treated with NaHS showed a lower malondialdehyde content, higher superoxide dismutase activity and glutathione content in intestine after CPR. Increased intestinal myeloperoxidase activity was significantly decreased by NaHS after CPR. Moreover, a reduced intestinal apoptotic cells after CPR were evident when pretreated with NaHS. Further studies indicated that NaHS enhances the expression of hypoxia-inducible factor-1α (HIF-1α) in intestine after CPR. Our data demonstrated that NaHS treatment before CPR induces intestinal mucosal protection 24h post-resuscitation. The protective effects may be through oxidative stress reduction, inflammation alleviation, apoptosis inhibition and HIF-1α activation. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Emergency medical service providers' experience with family presence during cardiopulmonary resuscitation.

    Science.gov (United States)

    Compton, Scott; Madgy, Alexander; Goldstein, Mark; Sandhu, Jaswinder; Dunne, Robert; Swor, Robert

    2006-08-01

    To describe emergency medical service providers' experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings. We conducted a personally distributed survey of a convenience sample of urban and suburban emergency medical service (EMS) providers presenting to two Midwestern Emergency Departments. Providers were questioned as to their experiences with resuscitating patients in the presence of family members. There were 128 respondents to the survey (59 urban and 69 suburban), of which 70.1% were EMT-Paramedics. No provider who was approached refused participation. Nearly all (122) had performed CPR in the presence of family members, with most (77%) performing greater than 20. Subjects averaged 12.3 years of experience. The majority of urban and suburban providers felt it was inappropriate for family to witness resuscitations (75.9% versus 60.3%, respectively; p=0.068). Many providers reported feeling uncomfortable with family presence (31.5% urban versus 44.8% suburban; p=0.136), and few preferred that family witness the resuscitation (13.2% urban versus 15.4 suburban; p=0.738). A minority of providers believed that family were better prepared to accept the death of the patient (37.0% urban versus 37.6% suburban; p=0.939). Approximately half felt comfortable providing emotional support (66.0% urban versus 53.7% suburban; p=0.173). Many felt that family caused a negative impact during resuscitation (53.7% urban and 36.8% suburban; p=0.061). Urban providers more often reported feeling threatened by family members during resuscitation (66.7% versus 39.7%; p=0.003), and felt that family often interfered with their ability to perform resuscitations (35.6% versus 16.4%, p=0.014). EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more

  15. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital.

    Science.gov (United States)

    Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Góis, Aécio Flávio Teixeira de; Batista, Ruth Ester Assayag

    2016-11-21

    to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC. comparar a taxa de retorno da circulação espontânea e óbito após parada cardiorrespiratória, com e sem a utilização do metrônomo durante ressuscitação cardiopulmonar. estudo caso-controle aninhado a estudo de coorte, com 285 adultos atendidos em parada cardíaca em um serviço de emergência e submetidos à ressuscitação cardiopulmonar. Os dados foram coletados por meio do In-hospital Utstein Style. O grupo controle (n=60) foi selecionado pelo pareamento dos pacientes considerando-se o estado neurológico pré-parada cardiorrespiratória, causa imediata e ritmo inicial da parada, utilização de epinefrina e duração da ressuscitação. O grupo caso (n=51) foi submetido à ressuscitação cardiopulmonar convencional com a utilização do metrônomo a 110sons/min. Para comparar

  16. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.

    Science.gov (United States)

    2006-05-01

    This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced

  17. A prospective study to determine the circumstances, incidence and outcome of cardiopulmonary resuscitation in a referral hospital in India, in relation to various factors

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    Muralidhar Joshi

    2015-01-01

    Full Text Available Background and Aims: Cardiac arrest has multifactorial aetiology and the outcome depends on timely and correct interventions. We decided to investigate the circumstances, incidence and outcome of cardiopulmonary resuscitation (CPR at a tertiary hospital in India, in relation to various factors, including extensive basic life support and advanced cardiac life support training programme for all nurses and doctors. Methods: It has been over a decade and a half with periodical updates and implementation of newer guidelines prepared by various societies across the world about CPR for both in-hospital and out-of hospital cardiac arrests (IHCA and OHCA. We conducted a prospective study wherein all cardiac arrests reported in the hospital consecutively for 12 months were registered for the study and followed their survival up to 1-year. Statistical analysis was performed by using Chi-square test for significant differences in proportions applied to various parameters of the study. Results: The main outcome measures were; (following CPR return of spontaneous circulation, survival for 24 h, survival from 24 h to 6 weeks or discharge, alive at 1-year. For survivors, an assessment was made about their cerebral performance and overall performance and accordingly graded. All these data were tabulated. Totally 419 arrests were reported in the hospital, out of which 413 were in-hospital arrests. Out of this 260 patients were considered for resuscitation, we had about 27 survivors at the end of 1-year follow-up (10.38%. Conclusion: We conclude by saying there are many factors involved in good clinical outcomes following IHCAs and these variable factors need to be researched further.

  18. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    Science.gov (United States)

    McCaul, Conán; Kornecki, Alik; Engelberts, Doreen; McNamara, Patrick; Kavanagh, Brian P

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival. Anesthetized Sprague-Dawley rats were exposed to 1 min of asphyxial cardiac arrest. Resuscitation was standardized and consisted of chest compressions, oxygen (Fio(2) 1.0), and IV epinephrine 30 microg/kg (Series 1) and 10 microg/kg (Series 2). Left ventricular function was assessed by echocardiography (Series 1), and animals were randomized to receive either 5 cm H(2)O PEEP or zero PEEP at commencement of CPR and throughout resuscitation. Survival was defined as the presence of a spontaneous circulation 60 or 120 min (Series 2) after initial resuscitation. There were no baseline differences between the groups. In Series 1, administration of 5 cm H(2)O PEEP (Fio(2) 1.0 and 0.21) was associated with improved survival compared with zero PEEP (7/9 and 6/6 vs 0/9, P CPR did not adversely affect left ventricular systolic function or arterial blood pressure. The outcome differences were not due to increased oxygenation because the rank order of survival was 5 cm H(2)O PEEP (Fio(2) 1.0) approximately 5 cm H(2)O PEEP (Fio(2) 0.21) > zero PEEP (Fio(2) 1.0), whereas the rank order of Pao(2) was 5 cm H(2)O PEEP (Fio(2) 1.0) > 5 cm H(2)O PEEP (Fio(2) 0.21) approximately zero PEEP (Fio(2) 1.0). In an additional series in which epinephrine 10 microg/kg was used (Series 2), the survival was 100% with no beneficial effects of PEEP. In asphyxial cardiac arrest in a small rodent model, continuous application of PEEP (5 cm H(2)O) during and after CPR had beneficial effects on survival that were independent of oxygenation and without adverse cardiovascular effects.

  19. Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

    Science.gov (United States)

    Dami, Fabrice; Fuchs, Vincent; Praz, Laurent; Vader, John-Paul

    2010-07-01

    In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery

  20. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  1. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  2. Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality.

    Science.gov (United States)

    Pammi, Mohan; Dempsey, Eugene M; Ryan, C Anthony; Barrington, Keith J

    2016-01-01

    Substantial health care resources are expended on standardised formal neonatal resuscitation training (SFNRT) programmes, but their effectiveness has not been proven. To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour. We searched CENTRAL, MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2015, and included randomised or quasi-randomised trials that reported at least one of our specified outcomes. SFNRT in low- and middle-income countries decreased early neonatal mortality [risk ratio (RR) 0.85 (95% CI 0.75-0.96)]; the number needed to treat for benefit [227 (95% CI 122-1,667; 3 studies, 66,162 participants, moderate-quality evidence)], and 28-day mortality [RR 0.55 (95% CI 0.33-0.91); 1 study, 3,355 participants, low-quality evidence]. Decreasing trends were noted for late neonatal mortality [RR 0.47 (95% CI 0.20-1.11)] and perinatal mortality [RR 0.94 (95% CI 0.87-1.00)], but there were no differences in fresh stillbirths [RR 1.05 (95% CI 0.93-1.20)]. Teamwork training with simulation increased the frequency of teamwork behaviour [mean difference (MD) 2.41 (95% CI 1.72-3.11)] and decreased resuscitation duration [MD -149.54 (95% CI -214.73 to -84.34); low-quality evidence, 2 studies, 130 participants]. SFNRT in low- and middle-income countries reduces early neonatal mortality, but its effects on birth asphyxia and neurodevelopmental outcomes remain uncertain. Follow-up studies suggest normal neurodevelopment in resuscitation survivors. © 2016 S. Karger AG, Basel.

  3. Randomized Controlled Trial of a Video Decision Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced Cancer

    Science.gov (United States)

    Volandes, Angelo E.; Paasche-Orlow, Michael K.; Mitchell, Susan L.; El-Jawahri, Areej; Davis, Aretha Delight; Barry, Michael J.; Hartshorn, Kevan L.; Jackson, Vicki Ann; Gillick, Muriel R.; Walker-Corkery, Elizabeth S.; Chang, Yuchiao; López, Lenny; Kemeny, Margaret; Bulone, Linda; Mann, Eileen; Misra, Sumi; Peachey, Matt; Abbo, Elmer D.; Eichler, April F.; Epstein, Andrew S.; Noy, Ariela; Levin, Tomer T.; Temel, Jennifer S.

    2013-01-01

    Purpose Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. Patients and Methods We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. Results The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P < .001). Mean knowledge scores were higher in the intervention arm than in the control arm (3.3 ± 1.0 v 2.6 ± 1.3, respectively; P < .001), and 65 participants (93%) in the intervention arm were comfortable watching the video. Conclusion Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative. PMID:23233708

  4. Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest.

    Science.gov (United States)

    Hassan, Mohammad Ahmad; Weber, Claudia; Waitz, Markus; Huang, Li; Hummler, Helmut D; Mendler, Marc Robin

    2017-01-01

    Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during progressive hypoxia, cardiac arrest, cardiopulmonary resuscitation (CPR), and after return of spontaneous circulation (ROSC). Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and then resuscitated until ROSC. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2) with one sensor applied to the wrist of the right forelimb (FL) and another to the thigh of the left hind limb (HL). Arterial functional oxygen saturation (SaO2) was measured at baseline and at predefined intervals during each phase of the experiment. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond ±5%. Bias values were lower at the baseline measurements (-3.7 ± 2.3% in FL and -4.1 ± 3.4% in HL) as well as after ROSC (1.5 ± 4.2% in FL and 0.2 ± 4.6% in HL) with higher precision and accuracy than during other experiment phases. During hypoxia induction, cardiac arrest, and CPR, there was a marked decrease in precision and accuracy as well as an increase in bias up to 43 ± 26 and 56 ± 27% in FL and HL, respectively, over a range of SaO2 from 13 to 51%. Pulse oximetry showed increased bias and decreased accuracy and precision during marked hypoxemia in a model of neonatal hypoxic cardiac arrest. © 2017 S. Karger AG, Basel.

  5. Aortic and right atrial systolic pressures during cardiopulmonary resuscitation: a potential indicator of the mechanism of blood flow.

    Science.gov (United States)

    Raessler, K L; Kern, K B; Sanders, A B; Tacker, W A; Ewy, G A

    1988-05-01

    The absolute difference between aortic and right atrial systolic pressure (systolic pressure gradient) and the difference between the aortic diastolic and right atrial diastolic pressure (coronary perfusion pressure) were evaluated in a series of 63 adult mongrel dogs undergoing five different methods of cardiopulmonary resuscitation (CPR). Fluid-filled pressure monitoring catheters were placed in the ascending aorta and right atrium in each of the animals after induction of anesthesia with morphine sulfate and 1% halothane and oxygen. The animals were then fibrillated with a transvenous electrode catheter that had been introduced into a ventricle. After a "down time" of 3 minutes during which no CPR was performed, the animals' lungs were ventilated, and one of five methods of CPR was initiated. The systolic pressure gradient and coronary perfusion pressure were measured in all animals 1 minute after CPR was begun, and in all but the group undergoing open-chest cardiac massage after 7 minutes and 17 minutes of CPR. The systolic pressure gradient and coronary perfusion pressure were greatest during open-chest cardiac massage (true cardiac compression), intermediate in external mechanical CPR (Thumper) and standard CPR (greater in small dogs than large dogs), and lowest in CPR performed with a combined thoracic and abdominal vest apparatus (predominantly thoracic pump). The observation that the systolic pressure gradient between intrathoracic chambers is largest in open-chest cardiac massage and smallest in vest CPR suggests that similar measurements recorded during the performance of human cardiac resuscitation may be useful in determining the mechanism of blood flow.

  6. Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement.

    Science.gov (United States)

    Boller, Manuel; Fletcher, Dan J; Brainard, Benjamin M; Haskins, Steve; Hopper, Kate; Nadkarni, Vinay M; Morley, Peter T; McMichael, Maureen; Nishimura, Ryohei; Robben, Joris H; Rozanski, Elizabeth; Rudloff, Elke; Rush, John; Shih, Andre; Smarick, Sean; Tello, Luis H

    2016-01-01

    To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology. Consensus guidelines. International, academia, referral practice, general practice, and human medicine. An international veterinary Utstein task force was convened in April 2013 in San Francisco to determine the scope of the project, the variables to be reported, their definitions, and a reporting template. Factors that were essential for meaningful data reporting and were amenable to accurate collection (ie, core variables) and additional variables useful for research projects and hypothesis generation (ie, supplemental variables) were defined. Consensus on each item was either achieved during that meeting or during the subsequent online modified Delphi process and dialogue between task force members. Variables were defined and categorized as hospital, animal, event (arrest), and outcome variables. This report recommends a template for standardized reporting of veterinary in-hospital CPR studies involving dogs or cats. Core elements include the suspected cause(s) and location of arrest, first rhythm identified, the occurrence of return of spontaneous circulation (ROSC) of more than 30 seconds (any ROSC) or more than 20 minutes (sustained ROSC), survival to discharge, and functional capacity at discharge. If CPR is discontinued or the patient is euthanized by owner request, a reason is reported. The task force suggests a case report form to be used for individual resuscitation events. The availability of these veterinary small animal CPR reporting guidelines will encourage and facilitate high-quality veterinary CPR research, improve data comparison between studies and across study sites, and serve as the foundation for veterinary CPR registries. © Veterinary Emergency and Critical Care Society 2015.

  7. Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive Care Unit.

    Science.gov (United States)

    Krochmal, Rebecca L; Blenko, John W; Afshar, Majid; Netzer, Giora; Roy, Susan C; Wiegand, Debra L; Shanholtz, Carl B

    2017-05-01

    The association of family-witnessed cardiopulmonary resuscitation (CPR) and subsequent advance directives in the medical intensive care unit is unknown. To compare clinical outcomes, including subsequent limitations on care, of family-witnessed vs family-unwitnessed CPR in the inpatient setting. Analysis of demographics and outcomes pertaining to family presence in a retrospective cohort of consecutive patients receiving first CPR in the medical intensive care unit of a tertiary academic medical center. In 5 years, 323 patients underwent attempted CPR, of which 49 attempts (15.2%) were witnessed by family. In patients with return of spontaneous circulation, 40.9% of those whose first CPR was witnessed by family later had a do not attempt resuscitation order, which did not differ from patients whose first CPR was unwitnessed by family (31.8%). Family-witnessed CPR in the unit was associated with significantly lower rates of return of spontaneous circulation (44.9%) than was family-unwitnessed CPR (62.0%; P = .02). Of all patients with a first CPR, 42 (13.0%) survived to hospital discharge. Only 1 patient with return of spontaneous circulation after first family-witnessed CPR survived to hospital discharge. In-hospital mortality for all patients requiring subsequent CPR was 97.1%. For unclear reasons, family-witnessed CPR in the medical intensive care unit is associated with a similar rate of subsequent CPR efforts and lower rates of return of spontaneous circulation and survival to hospital discharge. ©2017 American Association of Critical-Care Nurses.

  8. Two Hours of Teamwork Training Improves Teamwork in Simulated Cardiopulmonary Arrest Events.

    Science.gov (United States)

    Mahramus, Tara L; Penoyer, Daleen A; Waterval, Eugene M E; Sole, Mary L; Bowe, Eileen M

    2016-01-01

    Teamwork during cardiopulmonary arrest events is important for resuscitation. Teamwork improvement programs are usually lengthy. This study assessed the effectiveness of a 2-hour teamwork training program. A prospective, pretest/posttest, quasi-experimental design assessed the teamwork training program targeted to resident physicians, nurses, and respiratory therapists. Participants took part in a simulated cardiac arrest. After the simulation, participants and trained observers assessed perceptions of teamwork using the Team Emergency Assessment Measure (TEAM) tool (ratings of 0 [low] to 4 [high]). A debriefing and 45 minutes of teamwork education followed. Participants then took part in a second simulated cardiac arrest scenario. Afterward, participants and observers assessed teamwork. Seventy-three team members participated-resident physicians (25%), registered nurses (32%), and respiratory therapists (41%). The physicians had significantly less experience on code teams (P teamwork scores were 2.57 to 2.72. Participants' mean (SD) scores on the TEAM tool for the first and second simulations were 3.2 (0.5) and 3.7 (0.4), respectively (P teamwork educational intervention resulted in improved perceptions of teamwork behaviors. Participants reported interactions with other disciplines, teamwork behavior education, and debriefing sessions were beneficial for enhancing the program.

  9. Hypothermia and anesthetic postconditioning influence the expression and activity of small intestinal proteins possibly involved in ischemia/reperfusion-mediated events following cardiopulmonary resuscitation.

    Science.gov (United States)

    Albrecht, Martin; Gruenewald, Matthias; Zitta, Karina; Zacharowski, Kai; Scholz, Jens; Bein, Berthold; Meybohm, Patrick

    2012-01-01

    Successful resuscitation after cardiac arrest is typically associated with cerebral and myocardial ischemia/reperfusion (I/R)-injury. Recently, we have demonstrated effects of therapeutic hypothermia (HT) and postconditioning with the volatile anesthetic sevoflurane (SEV) on I/R-mediated mechanisms in the heart and brain [Meybohm et al., PLoS One, 2009; Meybohm et al., Crit Care, 2010]. As the intestine is also highly susceptible to I/R-injury, we investigated the influence of HT and SEV on intestinal I/R-mediated events induced by cardiac arrest and successful resuscitation. Effects of I/R, HT (12h, 33°C) and a combination of HT with SEV (12h, 2.0vol%) were evaluated in a pig model of cardiac arrest and successful cardiopulmonary resuscitation. Western blotting, ELISA, caspase-3/7 assays, myeloperoxidase (MPO) quantifications and gelatine zymography were performed using intestinal tissue derived 24h after return of spontaneous circulation. Compared to the normothermia control, HT and HT+SEV resulted in a significant increase in intestinal HIF-1α protein expression (Pintestine of animals treated with HT+SEV (Pintestinal MPO activity was found in the HT+SEV group (Pintestinal proteins that are possibly involved in intestinal I/R-mediated events following successful cardiopulmonary resuscitation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Different Techniques of Respiratory Support Do Not Significantly Affect Gas Exchange during Cardiopulmonary Resuscitation in a Newborn Piglet Model.

    Science.gov (United States)

    Mendler, Marc R; Maurer, Miriam; Hassan, Mohammad A; Huang, Li; Waitz, Markus; Mayer, Benjamin; Hummler, Helmut D

    2015-01-01

    There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR). We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO2 during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC. Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO2) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H2O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H2O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H2O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations. We found no significant differences in SaO2 between the three groups. However, there was a trend toward a higher SaO2 [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO2 [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group. We found no significant effect on gas exchange using different respiratory support strategies

  11. Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

    Directory of Open Access Journals (Sweden)

    Jui-Chen Tsai

    2012-09-01

    Conclusion: Although the initial resuscitation success rate was not affected by age, a longer time interval between the last medical staffs’ visit and the onset of resuscitation did result in a worse success rate in elderly patients. Our data suggest that more frequent staff visits to the elderly population during hospitalization could alter initial resuscitation results.

  12. The specific effect of metronome guidance on the quality of one-person cardiopulmonary resuscitation and rescuer fatigue.

    Science.gov (United States)

    Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Cho, Young Soon; Chung, Sung Phil; Park, Incheol; Kim, Seung Ho

    2012-12-01

    Metronome guidance is a simple and economic feedback method of guiding cardiopulmonary resuscitation (CPR). It has been proven for its usefulness in regulating the rate of chest compression and ventilation, but it is not yet clear how metronome use may affect compression depth or rescuer fatigue. The aim of this study was to assess the specific effect that metronome guidance has on the quality of CPR and rescuer fatigue. One-person CPRs were performed by senior medical students on Resusci Anne® manikins (Laerdal, Stavanger, Norway) with personal-computer skill-reporting systems. Half of the students performed CPR with metronome guidance and the other half without. CPR performance data, duration, and before-after trial differences in mean arterial pressure (MAP) and heart rate (HR) were compared between groups. Average compression depth (ACD) of the first five cycles, compression rate, no-flow fraction, and ventilation count were significantly lower in the metronome group (p=0.028, CPR duration, total work (ACD × total compression count), and the before-after trial differences of the MAP and HR did not differ between the two groups. Metronome guidance is associated with lower chest compression depth of the first five cycles, while shortening the no-flow fraction and the ventilation count in a simulated one-person CPR model. Metronome guidance does not have an obvious effect of intensifying rescuer fatigue. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Comparison of superior vena caval and inferior vena caval access using a radioisotope technique during normal perfusion and cardiopulmonary resuscitation

    International Nuclear Information System (INIS)

    Dalsey, W.C.; Barsan, W.G.; Joyce, S.M.; Hedges, J.R.; Lukes, S.J.; Doan, L.A.

    1984-01-01

    Recent studies of thoracic pressure changes during external cardiopulmonary resuscitation (CPR) suggest that there may be a significant difference in the rate of delivery of intravenous drugs when they are administered through the extrathoracic inferior vena cava (IVC) rather than the intrathoracic superior vena cava (SVC). Comparison of delivery of a radionuclide given using superior and inferior vena caval access sites was made during normal blood flow and during CPR. Mean times from injection to peak emission count in each ventricle were determined. There were no significant differences between mean peak times for SVC or IVC routes during normal flow or CPR. When peak times were corrected for variations in cardiac output, there were no significant differences between IVC and SVC peak times during normal flow. During CPR, however, mean left ventricular peak time, when corrected for cardiac output, was significantly shorter (P less than .05) when the SVC route was used. The mean time for the counts to reach half the ventricular peak was statistically shorter (P less than .05) in both ventricles with the SVC route during the low flow of CPR. This suggests that during CPR, increased drug dispersion may occur when drugs are infused by the IVC route and thus may modify the anticipated effect of the drug bolus. These results suggest that during CPR, both the cardiac output and the choice of venous access are important variables for drug delivery

  14. Electroencephalography reactivity for prognostication of post-anoxic coma after cardiopulmonary resuscitation: A comparison of quantitative analysis and visual analysis.

    Science.gov (United States)

    Liu, Gang; Su, Yingying; Jiang, Mengdi; Chen, Weibi; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan

    2016-07-28

    Electroencephalogram reactivity (EEG-R) is a positive predictive factor for assessing outcomes in comatose patients. Most studies assess the prognostic value of EEG-R utilizing visual analysis; however, this method is prone to subjectivity. We sought to categorize EEG-R with a quantitative approach. We retrospectively studied consecutive comatose patients who had an EEG-R recording performed 1-3 days after cardiopulmonary resuscitation (CPR) or during normothermia after therapeutic hypothermia. EEG-R was assessed via visual analysis and quantitative analysis separately. Clinical outcomes were followed-up at 3-month and dichotomized as recovery of awareness or no recovery of awareness. A total of 96 patients met the inclusion criteria, and 38 (40%) patients recovered awareness at 3-month followed-up. Of 27 patients with EEG-R measured with visual analysis, 22 patients recovered awareness; and of the 69 patients who did not demonstrated EEG-R, 16 patients recovered awareness. The sensitivity and specificity of visually measured EEG-R were 58% and 91%, respectively. The area under the receiver operating characteristic curve for the quantitative analysis was 0.92 (95% confidence interval, 0.87-0.97), with the best cut-off value of 0.10. EEG-R through quantitative analysis might be a good method in predicting the recovery of awareness in patients with post-anoxic coma after CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Randomised clinical simulation designed to evaluate the effect of telemedicine using Google Glass on cardiopulmonary resuscitation (CPR).

    Science.gov (United States)

    Pérez Alonso, Nuria; Pardo Rios, Manuel; Juguera Rodriguez, Laura; Vera Catalan, Tomas; Segura Melgarejo, Francisca; Lopez Ayuso, Belen; Martí Nez Riquelme, Carolina; Lasheras Velasco, Joaquin

    2017-11-01

    Through a clinical simulation, this study aims to assess the effect of telematics support through Google Glass (GG) from an expert physician on performance of cardiopulmonary resuscitation (CPR) performed by a group of nurses, as compared with a control group of nurses receiving no assistance. This was a randomised study carried out at the Catholic University of Murcia (November 2014-February 2015). Nursing professionals from the Emergency Medical Services in Murcia (Spain) were asked to perform in a clinical simulation of cardiac arrest. Half of the nurses were randomly chosen to receive coaching from physicians through GG, while the other half did not receive any coaching (controls). The main outcome of the study expected was successful defibrillation, which restores sinus rhythm. Thirty-six nurses were enrolled in each study group. Statistically significant differences were found in the percentages of successful defibrillation (100% GG vs 78% control; p=0005) and CPR completion times: 213.91 s for GG and 250.31 s for control (average difference=36.39 s (95% CI 12.03 to 60.75), p=0.004). Telematics support by an expert through GG improves success rates and completion times while performing CPR in simulated clinical situations for nurses in simulated scenarios. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. New guidelines for cardiopulmonary resuscitation Nuevas directrices para la resucitación cardiopulmonar Novas diretrizes da ressuscitação cardiopulmonar

    Directory of Open Access Journals (Sweden)

    Maria Celia Barcellos Dalri

    2008-12-01

    Full Text Available Cardiopulmonary arrest (CPA poses a severe threat to life; cardiopulmonary resuscitation (CPR represents a challenge for research and assessment by nurses and their team. This study presents the most recent international recommendations for care in case of cardiopulmonary heart arrest, based on the 2005 Guidelines by the American Heart Association (AHA. These CPR guidelines are based on a large-scale review process, organized by the International Liaison Committee on Resuscitation (ILCOR. High-quality basic and advanced CPR maneuvers can save lives.La parada cardiorrespiratoria (PCR es una ocurrencia que presenta una grave amenaza a la vida; la resucitación cardiopulmonar (RCP representa un desafío para la investigación y la evaluación por parte del enfermero y su equipo. Este estudio presenta las más recientes recomendaciones internacionales sobre la atención a la parada cardiorrespiratoria, basada en las Directrices de 2005 de la American Heart Asociation (AHA. Esas directrices sobre RCP se fundamentan en un proceso de revisión extenso, organizado por el International Liasion Committee on Resuscitation (ILCOR. Las maniobras básicas y avanzadas de RCP ofrecidas con calidad pueden salvar vidas.A parada cardiorrespiratória (PCR é intercorrência de grave ameaça à vida; a ressuscitação cardiopulmonar (RCP representa desafio para a investigação e a avaliação por parte do enfermeiro e sua equipe. Esse estudo apresenta as mais recentes recomendações internacionais sobre atendimento da parada cardiorrespiratória, baseado nas Diretrizes de 2005 da American Heart Association (AHA. Essas diretrizes sobre RCP fundamentam-se num processo de revisão extenso, organizado pelo International Liasion Committee on Resuscitation (ILCOR. As manobras básicas e avançadas de RCP com qualidade podem salvar vidas.

  17. The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session.

    Science.gov (United States)

    McKittrick, Joanne T; Kinney, Sharon; Lima, Sally; Allen, Meredith

    2018-01-01

    Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Return of spontaneous Circulation Is Not Affected by Different Chest Compression Rates Superimposed with Sustained Inflations during Cardiopulmonary Resuscitation in Newborn Piglets

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    Li, Elliott S.; Cheung, Po-Yin; Lee, Tze-Fun; Lu, Min; O'Reilly, Megan

    2016-01-01

    Objective Recently, sustained inflations (SI) during chest compression (CC) have been suggested as an alternative to the current approach during neonatal resuscitation. However, the optimal rate of CC during SI has not yet been established. Our aim was to determine whether different CC rates during SI reduce time to return of spontaneous circulation (ROSC) and improve hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and measurements Term newborn piglets were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized into three groups: CC superimposed by SI at a rate of 90 CC per minute (SI+CC 90, n = 8), CC superimposed by SI at a rate of 120 CC per minute (SI+CC 120, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation and respiratory parameters were continuously recorded throughout the experiment. Main results Both treatment groups had similar time of ROSC, survival rates, hemodynamic and respiratory parameters during cardiopulmonary resuscitation. The hemodynamic recovery in the subsequent 4h was similar in both groups and was only slightly lower than sham-operated piglets at the end of experiment. Conclusion Newborn piglets resuscitated by SI+CC 120 did not show a significant advantage in ROSC, survival, and hemodynamic recovery as compared to those piglets resuscitated by SI+CC 90. PMID:27304210

  19. Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest.

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    Lee, Byung Kook; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Kim, Nan Yeol; Heo, Tag; Min, Yong Il

    2015-02-01

    Ischaemic contracture compromises the haemodynamic effectiveness of cardiopulmonary resuscitation and resuscitability. 2,3-Butanedione monoxime (BDM) reduced ischaemic contracture by inhibiting actin-myosin crossbridge formation in an isolated heart model. We investigated the effects of BDM on ischaemic contracture and resuscitation outcomes in a pig model of out-of-hospital cardiac arrest (OHCA). After 15min of untreated ventricular fibrillation, followed by 8min of basic life support, 16 pigs were randomised to receive either 2mlkg(-1) of BDM solution (25gl(-1)) or 2mlkg(-1) of saline during advanced cardiac life support (ACLS). During the ACLS, the control group showed an increase in left ventricular (LV) wall thickness from 10.0mm (10.0-10.8) to 13.0mm (13.0-13.0) and a decrease in LV chamber area from 8.13cm(2) (7.59-9.29) to 7.47cm(2) (5.84-8.43). In contrast, the BDM group showed a decrease in the LV wall thickness from 10mm (9.0-10.8) to 8.5mm (7.0-9.8) and an increase in the LV chamber area from 9.86cm(2) (7.22-12.39) to 12.15 cm(2) (8.02-14.40). Mixed model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Spontaneous circulation was restored in four (50%) animals in the control group and in eight (100%) animals in the BDM group (p=0.077). All the resuscitated animals survived during an intensive care period of 4h. BDM administered during cardiopulmonary resuscitation reversed ischaemic contracture in a pig model of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Serious game versus online course for pretraining medical students before a simulation-based mastery learning course on cardiopulmonary resuscitation: A randomised controlled study.

    Science.gov (United States)

    Drummond, David; Delval, Paul; Abdenouri, Sonia; Truchot, Jennifer; Ceccaldi, Pierre-François; Plaisance, Patrick; Hadchouel, Alice; Tesnière, Antoine

    2017-12-01

    Although both recorded lectures and serious games have been used to pretrain health professionals before simulation training on cardiopulmonary resuscitation, they have never been compared. The aim of this study was to compare an online course and a serious game for pretraining medical students before simulation-based mastery learning on the management of sudden cardiac arrest. A randomised controlled trial. Participants were pretrained using the online course or the serious game on day 1 and day 7. On day 8, each participant was evaluated repeatedly on a scenario of cardiac arrest until reaching a minimum passing score. Department of Simulation in Healthcare in a French medical faculty. Eighty-two volunteer second-year medical students participated between June and October 2016 and 79 were assessed for primary outcome. The serious game used was Staying Alive, which involved a 3D realistic environment, and the online course involved a PowerPoint lecture. The median total training time needed for students to reach the minimum passing score on day 8. This same outcome was also assessed 4 months later. The median training time (interquartile range) necessary for students to reach the minimum passing score was similar between the two groups: 20.5 (15.8 to 30.3) minutes in the serious game group versus 23 (15 to 32) minutes in the online course group, P = 0.51. Achieving an appropriate degree of chest compression was the most difficult requirement to fulfil for students in both groups. Four months later, the median training time decreased significantly in both groups, but no correlation was found at an individual level with the training times observed on day 8. The serious game used in this study was not superior to an online course to pretrain medical students in the management of a cardiac arrest. The absence of any correlation between the performances of students evaluated during two training sessions separated by 4 months suggests that some elements in the

  1. A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

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    Brehaut Jamie C

    2008-11-01

    Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

  2. The effect of inclined step stool on the quality of chest compression during in-hospital cardiopulmonary resuscitation.

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    Yun, Seong-Woo; Lee, Byung Kook; Jeung, Kyung Woon; Park, Sang Wook; Choi, Sung Soo; Lee, Chang-Hee; Ryu, So-Yeon

    2014-08-01

    A step stool is an ordinary device to improve the quality of chest compression (CC) during in-hospital cardiopulmonary resuscitation (CPR). We investigated the effect of an inclined step stool on the quality of CC during CPR on a hospital bed. We conducted a randomized crossover study of simulation using a manikin. Two different methods of CC were performed and compared: CC using a flat stool and CC using an inclined (20°) stool. Each session of CC was performed for 2 minutes using a metronome at a rate of 110 beats per minute. The primary outcome was the depth of CC. The adequate CC rate, duty cycle, rate of incomplete recoil, and the angle between the arm of the participants and the bed were also measured. The median value of the mean depth of CC was 50.5 mm (45.0-57.0 mm) in the flat stool group and 54.5 mm (47.0-58.3 mm) in the inclined stool group (P = .014). The adequate CC rate was significantly higher in the inclined stool group (84.2% [37.6%-99.1%] vs 57.0% [15.2%-95.0%]; P = .016). The duty cycle and the rate of incomplete recoil were comparable between the 2 groups. The angles between the arm of the participants and the bed were more vertical in the inclined stool group (84.0° ± 5.2° vs 81.0° ± 4.8°; P = .014). Using an inclined stool resulted in an improvement in the depth of CC and the adequate CC rate without increasing the rate of incomplete chest recoil. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Cardiopulmonary resuscitation (CPR)-related posterior rib fractures in neonates and infants following recommended changes in CPR techniques.

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    Franke, I; Pingen, A; Schiffmann, H; Vogel, M; Vlajnic, D; Ganschow, R; Born, M

    2014-07-01

    Posterior rib fractures are highly indicative of non-accidental trauma (NAT) in infants. Since 2000, the "two-thumbs" technique for cardiopulmonary resuscitation (CPR) of newborns and infants has been recommended by the American Heart Association (AHA). This technique is similar to the grip on an infant's thorax while shaking. Is it possible that posterior rib fractures in newborns and infants could be caused by the "two-thumbs" technique? Using computerized databases from three German children's hospitals, we identified all infants less than 12 months old who underwent professional CPR within a 10-year period. We included all infants with anterior-posterior chest radiographs taken after CPR. Exclusion criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest radiographs were identified, and 50 of those infants underwent CPR immediately after birth. Data concerning the length of CPR was available for 41 infants. The mean length of CPR was 11min (range: 1-180min, median: 3min). On average, there were seven radiographs per infant. A total of 39 infants had a follow-up radiograph after at least 10 days. No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture after the use of the "two-thumbs" CPR technique is uncommon. Thus, there should be careful consideration of abuse when these fractures are identified, regardless of whether CPR was performed and what technique used. The discovery of rib fractures in an infant who has undergone CPR without underlying bone disease or major trauma warrants a full child protection investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Two-year survival and neurodevelopmental outcomes after cardiopulmonary resuscitation in neonatal patients after complex cardiac surgery.

    Science.gov (United States)

    Hansen, Gregory; Joffe, Ari R; Nettel-Aguirre, Alberto; Robertson, Charlene M T; Biggs, Wayne S G; Ross, David B; Rebeyka, Ivan M

    2011-03-01

    To examine survival and neurodevelopmental outcomes in neonates having post-operative cardiopulmonary resuscitation (CPR). This inception cohort study included all neonates (6 weeks old or less) who received postoperative CPR (Group 1) after cardiac surgery from 1996 to 2005, matched for heart defect, year of surgery, chromosomal abnormality, and socioeconomic status to two neonates who did not receive postoperative CPR (Group 2). Two-year neurodevelopment was prospectively assessed with Bayley Scales of Infant Development II and Adaptive Behavior Assessment System II. Pre-, intra-, and post-operative variables were collected prospectively. Cardiac arrest variables were collected retrospectively. Predictors of mortality were analyzed by univariate analysis and conditional multiple logistic regression. There were 29 patients in Group 1, and 58 patients in Group 2. In survivors, there were no significant differences between Groups 1 and 2 in outcomes [mean (SD)] of mental developmental index [84.5 (12.2) vs. 81.0 (18.9)], psychomotor developmental index [82.8 (13.8) vs. 80.1 (21.9)], General Adaptive Composite [84.6 (15.3) vs. 84.3 (19.2)], Motor scale [8.4 (3.2) vs. 8.0 (3.8)], or delay on any of these scales. Two-year mortality [58.6% Group 1; 8.6% Group 2], was associated on conditional multiple logistic regression with CPR (OR 26.6; 95% CI, 5.4, 129.5). In Group 1, on multiple logistic regression, 2-year mortality was associated with minutes of chest compressions (OR 1.04, 95% CI, 1.01, 1.08). Among neonates having cardiac surgery, CPR is associated with greater mortality. There is no evidence that CPR survivors have different 2-year neurodevelopmental outcomes than those neonates not having CPR. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  5. ROSC rates and live discharge rates after cardiopulmonary resuscitation by different CPR teams - a retrospective cohort study.

    Science.gov (United States)

    Oh, Tak Kyu; Park, Young Mi; Do, Sang-Hwan; Hwang, Jung-Won; Song, In-Ae

    2017-12-04

    Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is closely associated with patient outcomes. The aim of this study was to compare patient CPR outcomes across resident, emergency medicine, and rapid response teams. The records of patients who underwent CPR at the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2016 were analyzed retrospectively. Return of spontaneous circulation, 10- and 30-day survival, and live discharge after return of spontaneous circulation were compared across patients treated by the three CPR teams. Of the 1145 CPR cases, 444 (39%) were conducted by the resident team, 431 (38%) by the rapid response team, and 270 (23%) by the emergency medicine team. The adjusted odds ratios for the return of spontaneous circulation and subsequent 10-day survival among patients who received CPR from the resident team compared to the rapid response team were 0.59 (P = 0.001) and 0.71 (P = 0.037), respectively. There were no significant differences in the 30-day survival and rate of live discharge between patients who received CPR from the rapid response and resident teams; likewise, no significant differences were observed between patients who received CPR from the emergency medicine and rapid response teams. Patients receiving CPR from the rapid response team may have higher 10-day survival and return of spontaneous circulation rates than those who receive CPR from the resident team. However, our results are limited by the differences in approach, time of CPR, and room settings between teams.

  6. Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

    Science.gov (United States)

    Waninger, Kevin N; Goodbred, Andrew; Vanic, Keith; Hauth, John; Onia, Joshua; Stoltzfus, Jill; Melanson, Scott

    2014-07-01

    To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures. Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator. Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory. Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians. Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject. Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions. Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil. Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.

  7. A counterbalanced cross-over study of the effects of visual, auditory and no feedback on performance measures in a simulated cardiopulmonary resuscitation

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    Baxley Susan M

    2011-08-01

    Full Text Available Abstract Background Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR. Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only on the quality of CPR and rescuer fatigue. Methods Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter® software. Blood lactate (mmol/dl and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set a priori at 0.05. Results Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2% than did auditory (65.4 ± 7.6% or no feedback (44.5 ± 8.1%. Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute was less than it was with both visual and no feedback (p Conclusions In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback. The perfect confounding of sensory modality and periodicity of feedback (visual feedback provided continuously and auditory feedback provided to correct error leaves unanswered the question of optimal form and timing of feedback.

  8. Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya.

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    Newton Opiyo

    2008-02-01

    Full Text Available Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99% of deaths in developing countries. Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income settings is often outdated. Our aim was to determine if a simple one day newborn resuscitation training (NRT alters health worker resuscitation practices in a public hospital setting in Kenya.We conducted a randomised, controlled trial with health workers receiving early training with NRT (n = 28 or late training (the control group, n = 55. The training was adapted locally from the approach of the UK Resuscitation Council. The primary outcome was the proportion of appropriate initial resuscitation steps with the frequency of inappropriate practices as a secondary outcome. Data were collected on 97 and 115 resuscitation episodes over 7 weeks after early training in the intervention and control groups respectively. Trained providers demonstrated a higher proportion of adequate initial resuscitation steps compared to the control group (trained 66% vs control 27%; risk ratio 2.45, [95% CI 1.75-3.42], p<0.001, adjusted for clustering. In addition, there was a statistically significant reduction in the frequency of inappropriate and potentially harmful practices per resuscitation in the trained group (trained 0.53 vs control 0.92; mean difference 0.40, [95% CI 0.13-0.66], p = 0.004.Implementation of a simple, one day newborn resuscitation training can be followed immediately by significant improvement in health workers' practices. However, evidence of the effects on long term performance or clinical outcomes can only be established by larger cluster randomised trials.Controlled-Trials.com ISRCTN92218092.

  9. Effect of small-dose dopamine on mesenteric blood flow and renal function in a pig model of cardiopulmonary resuscitation with vasopressin.

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    Voelckel, W G; Lindner, K H; Wenzel, V; Bonatti, J O; Krismer, A C; Miller, E A; Lurie, K G

    1999-12-01

    Vasopressin (antidiuretic hormone) seems a promising alternative to epinephrine for cardiopulmonary resuscitation (CPR) in cardiac arrest victims, mediating a pronounced blood flow shift toward vital organs. We evaluated the effects of small-dose dopamine on splanchnic blood flow and renal function after successful resuscitation with this potent vasoconstrictor in an established porcine CPR model. After 4 min of cardiac arrest and 3 min of CPR, animals received 0.4 U/kg vasopressin and were continuously infused with either dopamine 4 microg x kg(-1) x min(-1) (n = 6), or saline placebo (n = 6). Defibrillation was performed 5 min after drug administration; all animals were observed for 6 h after return of spontaneous circulation. During the postresuscitation phase, average mean +/- SD superior mesenteric artery blood flow was significantly (P = 0.002) higher in the dopamine group compared with the placebo group (1185+/-130 vs 740+/-235 mL/min), whereas renal blood flow was comparable between groups (255+/-40 vs 250+/-85 mL/min). The median calculated glomerular filtration rate had higher values in the dopamine group (70-120 mL/min) than in the placebo group (40-70 mL/min; P = 0.1 at 0 min and P = 0.08 at 360 min). We conclude that small-dose dopamine administration may be useful in improving superior mesenteric artery blood flow and renal function after successful resuscitation with vasopressin. Long-term survival after cardiac arrest may be determined by the ability to ensure adequate organ perfusion during cardiopulmonary resuscitation and in the postresuscitation phase. In this regard, small-dose dopamine improved postresuscitation blood flow to the mesenteric bed when vasopressin was used as an alternative vasopressor in an animal model of cardiac arrest.

  10. Attitudes of ED staff to the presence of family during cardiopulmonary resuscitation: a Trinidad and Tobago perspective.

    Science.gov (United States)

    Mahabir, Dhiyan; Sammy, Ian

    2012-10-01

    Patients' relatives have been allowed in the resuscitation room during active resuscitation in the UK since at least 1994. Several studies have indicated that relatives value the opportunity to observe the care provided, and this has been shown to help the grieving process. However, this enthusiasm has not always been shared by emergency department staff. In Trinidad and Tobago the concept of family presence in the resuscitation room is still a novel one. This study seeks to identify the attitudes of staff towards relatives in the resuscitation room in this setting. A cross-sectional survey of attitudes of staff towards family presence in the resuscitation room was undertaken. All full-time doctors and nurses practising in emergency departments in the public sector in Trinidad and Tobago were surveyed, and the responses of doctors and nurses were compared. 214 individuals responded to the questionnaire (108 nurses and 106 doctors). 81.4% of respondents felt that relatives would be traumatised by witnessing resuscitation. 64% felt that staff performance would be inhibited by the presence of a family member during resuscitation. 71.1% believed that allowing a family member to witness resuscitation would prolong the resuscitation. 72% believed that witnessed resuscitation would increase the stress for the staff. Strong feelings against the presence of family members in the resuscitation room were expressed by physicians and nurses. Implementation of such a policy will require careful preparation and education of staff as to the benefits of this intervention.

  11. Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance

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    Jean-Paul Veronese

    2018-03-01

    Conclusion: Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

  12. The Effect of the Duration of Basic Life Support Training on the Learners’ Cardiopulmonary and Automated External Defibrillator Skills

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    Jin Hyuck Lee

    2016-01-01

    Full Text Available Background. Basic life support (BLS training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR and automated external defibrillator (AED skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min, level 2 (80 min, level 3 (120 min, and level 4 (180 min. Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p<0.001 and average chest compression depth (p=0.003. All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p<0.001. Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.

  13. Rescuers' effect on active compression-decompression cardiopulmonary resuscitation (ACD-CPR) operating.

    Science.gov (United States)

    Chi, Chih-Hsien; Wu, Fong-Gong; Wu, Tsung-Hsiey

    2003-11-01

    The purpose of this study is to consider the perceptions of rescuers of ACD operation and their anatomy characteristics are evaluated to yield a better understanding on operation of ACD. A prospective, descriptive study to evaluate professional providers received ACD training. A total of 39 emergency medical professional participated in this study. CPR is performed as both ACD and standard CPR on a manikin separately. 56.4% of the participants felt that the ACD device was not easy or was very difficult to use. The easy-to-use group had a greater height, shoulder to iliac crest distance, shoulder to knee distance, and forearm length. The taller rescuers operate ACD more easily. In addition, women might operate ACD more difficultly. Modifying the operation of ACD (such as by putting a blanket put under the rescuer's knee or using footstool) was recommended and seems reasonable. These issues should be addressed on training.

  14. Adequacy of Physicians Knowledge Level of Cardiopulmonary Resuscitation to Current Guidelines

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    Ümmu Kocalar

    2016-01-01

    Full Text Available Aim: The purpose of this study is to test the level of information on CPR and suitability to current application of the phsicians practicing in hospital ANEAH. Material and Method: The form of a test of 20 questions fort his purpose has been prepared in accordance with the 2010 AHA-ERC CPR guidelines. This form distributed to volunteer physicians to fill in. A total of 173 physicians agreed to participate in he study. The results were analyzed statistically and tried to determine the factors affecting the level of information. Results:According to the results of the study physicians gender, age and the total duration of physicians and medical asistance doesn%u2019t affect the level of information. The number of CPR within 1 month positively affect the level of knowledge. The number of theoretical and practical training in medical school, have taken the positive impact the level of knowledge of physicians. The training period after graduation, significantly increased the level of physicians information. The order of these training sessions with the asistant courses, congress, seminars and lessions on the sempozims are effective. Discussion: CPR trainig programs for physicians should be standardized, updated and expanded. Recurent in-service trainig should be provided to increase phsicians knowledge on skills.

  15. Family Support During Resuscitation: A Quality Improvement Initiative.

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    Mureau-Haines, Rache Marie; Boes-Rossi, Mandy; Casperson, Susan Christine; Çoruh, Basak; Furth, Amy M; Haverland, Amy; Herrera, Farah; Hirai-Seaton, Tracy; Kummet, Carol; Ngo, Hkori; Shushan, Stephanie; Kritek, Patricia A; Greco, Sheryl A

    2017-12-01

    Despite increasing support for family presence during cardiopulmonary resuscitation, a review of the literature revealed no published protocols or training curricula to guide hospitals in implementing a family support provider role. To develop a curriculum and train dedicated resuscitation team members whose role is to provide family support during in-hospital resuscitation events. An interdisciplinary team developed a 4-hour training session for the family support staff. The session included an introduction to the evidence for family presence during resuscitation and local data on resuscitations. The training was composed of 4 sections: (1) clinical aspects of resuscitation, (2) integration into the resuscitation team and steps for providing family support during resuscitation, (3) responding to families in distress, and (4) self-care practices. Before and after the training session, the participants completed surveys of self-rated knowledge and attitudes toward family presence during resuscitation. Fifty-nine social workers and 8 spiritual care providers were trained in 2015. There was a significant increase in all rated aspects of knowledge of the family support role and self-care strategies. Through the creation of an interdisciplinary curriculum, an institution can effectively train health care providers in a new resuscitation team role: the family support provider. © 2017 American Association of Critical-Care Nurses.

  16. Effects of Blended Cardiopulmonary Resuscitation and Defibrillation E-learning on Nursing Students' Self-efficacy, Problem Solving, and Psychomotor Skills.

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    Park, Ju Young; Woo, Chung Hee; Yoo, Jae Yong

    2016-06-01

    This study was conducted to identify the educational effects of a blended e-learning program for graduating nursing students on self-efficacy, problem solving, and psychomotor skills for core basic nursing skills. A one-group pretest/posttest quasi-experimental design was used with 79 nursing students in Korea. The subjects took a conventional 2-week lecture-based practical course, together with spending an average of 60 minutes at least twice a week during 2 weeks on the self-guided e-learning content for basic cardiopulmonary resuscitation and defibrillation using Mosby's Nursing Skills database. Self- and examiner-reported data were collected between September and November 2014 and analyzed using descriptive statistics, paired t test, and Pearson correlation. The results showed that subjects who received blended e-learning education had improved problem-solving abilities (t = 2.654) and self-efficacy for nursing practice related to cardiopulmonary resuscitation and defibrillation (t = 3.426). There was also an 80% to 90% rate of excellent postintervention performance for the majority of psychomotor skills, but the location of chest compressions, compression rate per minute, artificial respiration, and verification of patient outcome still showed low levels of performance. In conclusion, blended E-learning, which allows self-directed repetitive learning, may be more effective in enhancing nursing competencies than conventional practice education.

  17. Use of backboard and deflation improve quality of chest compression when cardiopulmonary resuscitation is performed on a typical air inflated mattress configuration.

    Science.gov (United States)

    Oh, Jaehoon; Kang, Hyunggoo; Chee, Youngjoon; Lim, Taeho; Song, Yeongtak; Cho, Youngsuk; Je, Sangmo

    2013-02-01

    No study has examined the effectiveness of backboards and air deflation for achieving adequate chest compression (CC) depth on air mattresses with the typical configurations seen in intensive care units. To determine this efficacy, we measured mattress compression depth (MCD, mm) on these surfaces using dual accelerometers. Eight cardiopulmonary resuscitation providers performed CCs on manikins lying on 4 different surfaces using a visual feedback system. The surfaces were as follows: A, a bed frame; B, a deflated air mattress placed on top of a foam mattress laid on a bed frame; C, a typical air mattress configuration with an inflated air mattress placed on a foam mattress laid on a bed frame; and D, C with a backboard. Deflation of the air mattress decreased MCD significantly (B; 14.74 ± 1.36 vs C; 30.16 ± 3.96, P deflation of the air mattress decreased MCD more than use of a backboard (B; 14.74 ± 1.36 vs D; 25.46 ± 2.89, P = 0.002). The use of a both a backboard and a deflated air mattress in this configuration reduces MCD and thus helps achieve accurate CC depth during cardiopulmonary resuscitation.

  18. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style.

    Science.gov (United States)

    Reis, Amelia G; Nadkarni, Vinay; Perondi, Maria Beatriz; Grisi, Sandra; Berg, Robert A

    2002-02-01

    Data regarding pediatric in-hospital cardiopulmonary resuscitation (CPR) have been limited because of retrospective study designs, small sample sizes, and inconsistent definitions of cardiac arrest and CPR. The purpose of this study was to prospectively describe and evaluate pediatric in-hospital CPR with the international consensus-derived epidemiologic definitions from the Utstein guidelines. All 129 in-hospital CPRs during 12 months at a 122-bed university children's hospital in Sao Paulo, Brazil, were described and evaluated using Utstein reporting guidelines. These guidelines include standardized descriptions of hospital variables, patient variables, arrest/event variables, and outcome variables. CPR was defined as chest compressions and assisted ventilation provided because of cardiac arrest or because of severe bradycardia with poor perfusion. Outcome variables included sustained return of spontaneous circulation, 24-hour survival, 30-day survival, 1-year survival, and neurologic status of survivors by the Pediatric Cerebral Performance Category Scale. Of the 6024 children admitted to the hospital, 176 (3%) had an episode that met the criteria for provision of CPR and 129 (2%) received CPR, 86 for clinical cardiac arrest and 43 for bradycardia with poor perfusion. Most of the children (71%) had preexisting chronic diseases. The most common precipitating causes were respiratory failure (61%) and shock (29%). The initial cardiac rhythm was asystole in 71 children (55%), pulseless electrical activity in 12 (9%), ventricular fibrillation in 1, and bradycardia with pulses and poor perfusion in 43 (33%). Eighty-three children (64%) attained sustained return of spontaneous circulation (>20 minutes), 43 (33%) were alive at 24 hours, 24 (19%) were alive at 30 days, and 19 (15%) were alive at 1 year. Although many factors correlated with 24-hour survival, multivariate logistic regression analysis revealed independent association of 24-hour survival with respiratory

  19. Programa de capacitação em ressuscitação cardiorrespiratória com uso do desfibrilador externo automático em uma universidade Programa de formación en reanimación cardiopulmonar con el uso del desfibrilador externo automático en una universidad Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university

    Directory of Open Access Journals (Sweden)

    Ana Paula Boaventura

    2012-03-01

    .Early defibrillation in cardiopulmonary resuscitation (CPR receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment, the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points; in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory and skill (pratice for the care of CPR victims.

  20. Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.

    Science.gov (United States)

    Alsoufi, Bahaaldin; Awan, Abid; Manlhiot, Cedric; Guechef, Alexander; Al-Halees, Zohair; Al-Ahmadi, Mamdouh; McCrindle, Brian W; Kalloghlian, Avedis

    2014-02-01

    Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P=0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P=0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P=0.37). Survivors had shorter CPR duration (25 vs 34 min, P=0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P=0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P<0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P=0.008) and renal failure requiring haemodialysis (OR 14.1, P=0.01). ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance

  1. Análise crítica das novas recomendações para reanimação cardiopulmonar The new guidelines for cardiopulmonary resuscitation: a critical analysis

    Directory of Open Access Journals (Sweden)

    Liliane Zorzela

    2007-05-01

    cardiac arrest, basic life support, advanced life support, cardiopulmonary resuscitation and pediatric resuscitation. SUMMARY OF THE FINDINGS: The greatest guideline changes are in the area of basic life support. The new guidelines emphasize the new chest compression/ventilation ratio for trained health professionals, which is now 15:2 for all children except neonates. Also emphasized is the need for harder and faster chest compressions, and the need to avoid hyperventilation during and after cardiorespiratory arrest. The use of high-dose epinephrine has been removed, as have some other previous recommendations. CONCLUSIONS: The most recent AHA guidelines for pediatric resuscitation are focused primarily on basic life support care. They are based on the best available scientific evidence, although further research is required to validate these changes and provide new evidence for future guidelines.

  2. Barriers to patient positioning for telephone cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Langlais, Blake T; Panczyk, Micah; Sutter, John; Fukushima, Hidetada; Wu, Zhixin; Iwami, Taku; Spaite, Daniel; Bobrow, Bentley

    2017-06-01

    9-1-1 callers often face barriers preventing them from starting Telephone CPR (TCPR). The most common problem is getting patients to a hard, flat surface. This study describes barriers callers report when trying to move patients to a hard, flat surface and assesses conditions associated with overcoming these barriers. We audited 2396 out-of-hospital cardiac arrest (OHCA) audio recordings. A barrier was defined as any statement by the caller that the rescuer could not move the patient to the ground and into a supine position. Barriers were recorded and TCPR process metrics compared across the barrier and non-barrier groups. There were 802 OHCAs in the study group. Roughly 26% had a barrier. Telecommunicators were less likely to start TCPR instructions in the barrier group than in the non-barrier group (OR: 0.63, 95% CI: 0.45-0.88; p=0.007). Telecommunicator-directed bystander chest compressions were more than twice as likely to start in the non-barrier group (OR: 2.2, 95% CI: 1.6-3.2; p<0.001). Median time to first compression was longer in the barrier group (276s vs 171s; p<0.001). Rescuers were 3.7 times more likely to overcome a barrier and start compressions (OR: 3.7, 95% CI: 2.0-6.8; p<0.001) when multiple bystanders were present. Inability to move patients to a hard, flat surface is associated with a reduced rate of TCPR and increased time to first compression. Assessing the conditions under which such barriers are overcome is important for telecommunicator training and can help improve rates and timeliness of TCPR. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation.

    Science.gov (United States)

    Gregson, Rachael Kathleen; Cole, Tim James; Skellett, Sophie; Bagkeris, Emmanouil; Welsby, Denise; Peters, Mark John

    2017-05-01

    To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used. Randomised crossover trial. Tertiary teaching hospital. Fifty trained hospital staff. A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions. During one session they received visual feedback comparing their real-time rate with published guidelines. Primary: compression rate. Secondary: compression and residual forces. Rate of chest compressions (compressions per minute (compressions per minute; cpm)) varied widely (mean (SD) 111 (13), range 89-168), with a fourfold difference in variation during session 1 between those receiving and not receiving feedback (108 (5) vs 120 (20)). The interaction of session by feedback order was highly significant, indicating that this difference in mean rate between sessions was 14 cpm less (95% CI -22 to -5, p=0.002) in those given feedback first compared with those given it second. Compression force (N) varied widely (mean (SD) 306 (94); range 142-769). Those receiving feedback second (as opposed to first) used significantly lower force (adjusted mean difference -80 (95% CI -128 to -32), p=0.002). Mean residual force (18 N, SD 12, range 0-49) was unaffected by the intervention. While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest.

    Science.gov (United States)

    Hunt, Elizabeth A; Heine, Margaret; Shilkofski, Nicole S; Bradshaw, Jamie Haggerty; Nelson-McMillan, Kristen; Duval-Arnould, Jordan; Elfenbein, Ron

    2015-03-01

    To assess whether access to a voice activated decision support system (VADSS) containing video clips demonstrating resuscitation manoeuvres was associated with increased compliance with American Heart Association Basic Life Support (AHA BLS) guidelines. This was a prospective, randomised controlled trial. Subjects with no recent clinical experience were randomised to the VADSS or control group and participated in a 5-min simulated out-of-hospital cardiopulmonary arrest with another 'bystander'. Data on performance for predefined outcome measures based on the AHA BLS guidelines were abstracted from videos and the simulator log. 31 subjects were enrolled (VADSS 16 vs control 15), with no significant differences in baseline characteristics. Study subjects in the VADSS were more likely to direct the bystander to: (1) perform compressions to ventilations at the correct ratio of 30:2 (VADSS 15/16 (94%) vs control 4/15 (27%), p=compressor versus ventilator roles after 2 min (VADSS 12/16 (75%) vs control 2/15 (13%), p=0.001). The VADSS group took longer to initiate chest compressions than the control group: VADSS 159.5 (±53) s versus control 78.2 (±20) s, pcontrol 75.4 (±8.0), p=0.35. The use of an audio and video assisted decision support system during a simulated out-of-hospital cardiopulmonary arrest prompted lay rescuers to follow cardiopulmonary resuscitation (CPR) guidelines but was also associated with an unacceptable delay to starting chest compressions. Future studies should explore: (1) if video is synergistic to audio prompts, (2) how mobile technologies may be leveraged to spread CPR decision support and (3) usability testing to avoid unintended consequences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death.

    Science.gov (United States)

    Fernández-Aedo, I; Pérez-Urdiales, I; Unanue-Arza, S; García-Azpiazu, Z; Ballesteros-Peña, S

    To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

    Directory of Open Access Journals (Sweden)

    Samar Noureddine

    2016-01-01

    Full Text Available Background: The survival rate of out-of-hospital cardiac arrest (OHCA victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany. Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%, underlying cardiac rhythm (93.1%, the physician's ethical duty to resuscitate (93.2%, transport time to the ED (89%, and down time (84.9%. The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8% and lack of policy (30%. Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.

  7. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

    Science.gov (United States)

    Noureddine, Samar; Avedissian, Tamar; Isma’eel, Hussain; El Sayed, Mazen J.

    2016-01-01

    Background: The survival rate of out-of-hospital cardiac arrest (OHCA) victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs) was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany). Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants’ decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%), underlying cardiac rhythm (93.1%), the physician’s ethical duty to resuscitate (93.2%), transport time to the ED (89%), and down time (84.9%). The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival) and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim’s family (38.8%) and lack of policy (30%). Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim’s family wishes. The findings support the need for a national policy on resuscitation of OHCA victims. PMID:27512333

  8. [Resuscitation training for lay persons in first aid courses: Transfer of knowledge, skills and attitude].

    Science.gov (United States)

    Breckwoldt, J; Lingemann, C; Wagner, P

    2016-01-01

    Bystander cardiopulmonary resuscitation (CPR) is the most effective intervention for out of hospital sudden cardiac arrest; therefore, basic life support (BLS) courses for lay persons have become well established in industrialized countries, often since decades. Despite this favorable situation bystander CPR rates still remain low in some countries (e.g. in Germany), indicating serious implementation problems. The quality of instruction in these courses could be one reason for low bystander CPR rates. We therefore analyzed official lay BLS courses in terms of the teaching quality in the domains of knowledge, skills and attitudes (according to Bloom's taxonomy). A total of 20 officially accredited lay BLS courses in Berlin, Germany, were analyzed by a participating observer, who remained blinded to the instructor and course participants until the end of the course. Courses were offered by German rescue organizations and private providers according to European Resuscitation Council (ERC) guidelines. Teaching quality was rated by a standardized checklist including 21 observable criteria of teaching quality for transfer of knowledge (n = 10), skills (n = 8) and attitudes (n = 3). In order to achieve comparability between items the results of each criterion were quantified by Likert scales ranging from +2 (very good) to -2 (very poor). The average score of all courses was +0.47 (SD ±0.46) for transfer of knowledge, +0.03 (SD ±0.61) for skills and -1.08 (SD ±0.73) for attitudes. In the domain of knowledge transfer, learning atmosphere and course structure were rated to be generally good, whilst marked deficits were found with respect to correctness of content. In the domain of skills the more positive ratings were given for teaching of single BLS elements (e.g. compressions and ventilation), in contrast to the training of BLS context, where e.g. realistic scenarios were only used by 3 out of 20 instructors. The domain of attitude transfer had the worst

  9. Paediatric resuscitation training: is e-learning the answer? A before and after pilot study.

    Science.gov (United States)

    O'Leary, Fenton M

    2012-06-01

    To determine whether an e-learning resuscitation programme was able to improve the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in a simulated cardiac arrest. A prospective before and after pilot study comprising of a simulated paediatric resuscitation before and after participants undertook an e-learning programme. Participants were emergency department doctors and new graduate nurses from The Children's Hospital at Westmead, Australia. Primary outcome measures were the ability to perform successful basic life support (BLS) and advanced life support (ALS) according to published guidelines. Secondary outcome measures were the individual steps in performing the overall resuscitation and subjective feedback from participants. Fifty-six clinicians were enrolled in the study (29 doctors and 27 nurses). Thirty-seven were re-tested (25 doctors and 12 nurses). The mean time between tests was 49 days (17 standard deviation). The e-learning module led to an improvement in participants' ability to perform BLS by 51% (P < 0.001) and ALS by 57% (P= 0.001) overall resulting in an overall competence of 89% (BLS) and 65% (ALS). There were also significant improvements in time to rhythm recognition (P= 0.006), time to first defibrillation (P= 0.009) and participants' self-reported knowledge and confidence in BLS and ALS (P < 0.001). E-learning does improve both the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in the simulation environment. © 2011 The Author. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  10. Cardiopulmonary-cerebral resuscitation

    African Journals Online (AJOL)

    The brain is the organ most sensitive to hypoxia. The brain cannot store oxygen and has a very limited capacity for anaerobic metabolism. Permanent brain damage will thus result after three to four minutes of total hypoxia at normal temperatures. Should cerebral blood flow be restored after such an incident, the patient may ...

  11. A counterbalanced cross-over study of the effects of visual, auditory and no feedback on performance measures in a simulated cardiopulmonary resuscitation.

    Science.gov (United States)

    Cason, Carolyn L; Trowbridge, Cynthia; Baxley, Susan M; Ricard, Mark D

    2011-08-02

    Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR). Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only) on the quality of CPR and rescuer fatigue. Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter® software. Blood lactate (mmol/dl) and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set a priori at 0.05. Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2%) than did auditory (65.4 ± 7.6%) or no feedback (44.5 ± 8.1%). Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute) was less than it was with both visual and no feedback (p < 0.05). CPR performed with no feedback (39.2 ± 0.5 mm) yielded a shallower average depth of compression and a lower percentage (55 ± 8.9%) of compressions within the accepted 38-50 mm range than did auditory or visual feedback (p < 0.05). The duty cycle for auditory feedback (39.4 ± 1.6%) was less than it was with no feedback (p < 0.05). Auditory feedback produced lower lactate concentrations than did visual feedback (p < 0.05) but there were no differences in perceived exertion. In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback

  12. Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence?

    NARCIS (Netherlands)

    Krage, R.; Zwaan, L.; Tjon Soei Len, L.; Kolenbrander, M.; Groeningen, D. van; Loer, S.A.; Wagner, C.; Schober, P.

    2017-01-01

    Background: Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary

  13. Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study.

    Science.gov (United States)

    Krupičková, Petra; Mlček, Mikuláš; Huptych, Michal; Mormanová, Zuzana; Bouček, Tomáš; Belza, Tomáš; Lacko, Stanislav; Černý, Miloš; Neužil, Petr; Kittnar, Otomar; Linhart, Aleš; Bělohlávek, Jan

    2016-06-08

    Current research highlights the role of microcirculatory disorders in post-cardiac arrest patients. Affected microcirculation shows not only dissociation from systemic hemodynamics but also strong connection to outcome of these patients. However, only few studies evaluated microcirculation directly during cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). The aim of our experimental study in a porcine model was to describe sublingual microcirculatory changes during CA and CPR using recent videomicroscopic technology and provide a comparison to parameters of global hemodynamics. Cardiac arrest was induced in 18 female pigs (50 ± 3 kg). After 3 min without treatment, 5 min of mechanical CPR followed. Continuous hemodynamic monitoring including systemic blood pressure and carotid blood flow was performed and blood lactate was measured at the end of baseline and CPR. Sublingual microcirculation was assessed by the Sidestream Dark Field (SDF) technology during baseline, CA and CPR. Following microcirculatory parameters were assessed off-line separately for capillaries (≤20 µm) and other vessels: total and perfused vessel density (TVD, PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) and heterogeneity index (HI). In comparison to baseline the CA small vessel microcirculation was only partially preserved: TVD 15.64 (13.59-18.48) significantly decreased to 12.51 (10.57-13.98) mm/mm(2), PVD 15.57 (13.56-17.80) to 5.53 (4.17-6.60) mm/mm(2), PPV 99.64 (98.05-100.00) to 38.97 (27.60-46.29) %, MFI 3.00 (3.00-3.08) to 1.29 (1.08-1.58) and HI increased from 0.08 (0.00-0.23) to 1.5 (0.71-2.00), p = 0.0003 for TVD and CPR in small vessels reached 59-85 % of the baseline values: TVD 13.33 (12.11-15.11) mm/mm(2), PVD 9.34 (7.34-11.52) mm/mm(2), PPV 72.34 (54.31-87.87) %, MFI 2.04 (1.58-2.42), HI 0.65 (0.41-1.07). The correlation between microcirculation and global hemodynamic parameters as well as to lactate was only weak to

  14. [Early evaluation of patients with amplitude-integrated electroencephalogram on brain function prognosis after cardiopulmonary cerebral resuscitation].

    Science.gov (United States)

    Dong, Xin; Shao, Huanzhang; Yang, Yanan; Qin, Lijie; Guo, Zhisong; Zhang, Huifeng; Zhang, Xueyan; Qin, Bingyu

    2017-10-01

    To explore the characteristic of early evaluation of patients with amplitude-integrated electroencephalogram (aEEG) on brain function prognosis after cardiopulmonary cerebral resuscitation (CPCR). A retrospective analysis of the clinical data of patients with adult CPCR in intensive care unit (ICU) of Henan Provincial People's Hospital from March 2016 to March 2017 was performed. The length of stay, recovery time, acute physiology and chronic health evaluation II (APACHE II) score, aEEG and Glasgow coma scale (GCS) within 72 hours were recorded. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients with CPCR after 3 months. Relationship between aEEG and GCS and their correlation with brain function prognosis was analyzed by Spearman rank correlation analysis. The effects of aEEG and GCS on prognosis of brain function were evaluated by Logistic regression analysis. The predictive ability of aEEG and GCS for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. A total of 31 patients with CPCR were enrolled, with 18 males and 13 females; mean age was (41.84±16.96) years old; recovery time average was (19.42±10.79) minutes; the length of stay was (14.84±10.86) days; APACHE II score 19.29±6.42; aEEG grade I (normal amplitude) in 7 cases, grade II (mild to moderate abnormal amplitude) in 13 cases, grade III (severe abnormal amplitude) in 11 cases; GCS grade I (9-14 scores) in 7 cases, grade II (4-8 scores) in 14 cases, grade III (3 scores) in 10 cases; 19 survivals, 12 deaths; the prognosis of brain function was good (CPC 1-2) in 8 cases, and the prognosis of brain function was poor (CPC 3-5) in 23 cases. There was no significant difference in age, gender, recovery time, length of stay and APACHE II score between two groups with different brain function prognosis, while aEEG grade and GCS grade were significantly different. Cochran-Armitage trend test

  15. Peer-led training in basic life support and resuscitation using an automatic external defibrillator

    DEFF Research Database (Denmark)

    Løfgren, Bo; Petersen, Christina Børlum; Mikkelsen, Ronni

    2009-01-01

    Peer-led training has been identified as a useful tool for delivering undergraduate healthcare training. In this paper we describe the implementation of the European Resuscitation Council BLS/AED Course as a peer-led training program for medical students....

  16. The impact of CPR and AED training on healthcare professionals' self-perceived attitudes to performing resuscitation

    Directory of Open Access Journals (Sweden)

    Källestedt Marie-Louise

    2012-04-01

    Full Text Available Abstract Background Healthcare professionals have shown concern about performing mouth-to-mouth ventilation due to the risks to themselves with the procedure. However, little is known about healthcare professionals' fears and attitudes to start CPR and the impact of training. Objective To examine whether there were any changes in the attitudes among healthcare professionals to performing CPR from before to after training. Methods Healthcare professionals from two Swedish hospitals were asked to answer a questionnaire before and after training. The questions were relating to physical and mental discomfort and attitudes to CPR. Statistical analysis used was generalized McNemar's test. Results Overall, there was significant improvement in 10 of 11 items, reflecting various aspects of attitudes to CPR. All groups of health care professionals (physicians, nurses, assistant nurses, and "others" = physiotherapists, occupational therapists, social welfare officers, psychologists, biomedical analysts felt more secure in CPR knowledge after education. In other aspects, such as anxiety prior to a possible cardiac arrest, only nurses and assistant nurses improved. The concern about being infected, when performing mouth to mouth ventilation, was reduced with the most marked reduction in physicians (75%; P Conclusion In this hospital-based setting, we found a positive outcome of education and training in CPR concerning healthcare professionals' attitudes to perform CPR. They felt more secure in their knowledge of cardiopulmonary resuscitation. In some aspects of attitudes to resuscitation nurses and assistant nurses appeared to be the groups that were most markedly influenced. The concern of being infected by a disease was low.

  17. [Reproducing and evaluating a rabbit model of multiple organ dysfunction syndrome after cardiopulmonary resuscitation resulted from asphyxia].

    Science.gov (United States)

    Zhang, Dong; Li, Nan; Chen, Ying; Wang, Yu-shan

    2013-02-01

    To evaluate the reproduction of a model of post resuscitation multiple organ dysfunction syndrome (PR-MODS) after cardiac arrest (CA) in rabbit, in order to provide new methods for post-CA treatment. Thirty-five rabbits were randomly divided into three groups, the sham group (n=5), the 7-minute asphyxia group (n=15), and the 8-minute asphyxia group (n=15). The asphyxia CA model was reproduced with tracheal occlusion. After cardiopulmonary resuscitation (CPR), the ratio of recovery of spontaneous circulation (ROSC), the mortality at different time points and the incidence of systemic inflammatory response syndrome (SIRS) were observed in two asphyxia groups. Creatine kinase isoenzyme (CK-MB), alanine aminotransferase (ALT), creatinine (Cr), glucose (Glu) and arterial partial pressure of oxygen (PaO2) levels in blood were measured in the two asphyxia groups before CPR and 12, 24 and 48 hours after ROSC. The survived rabbits were euthanized at 48 hours after ROSC, and heart, brain, lung, kidney, liver, and intestine were harvested for pathological examination using light microscope. PR-MODS after CA was defined based on the function of main organs and their pathological changes. (1) The incidence of ROSC was 100.0% in 7-minute asphyxia group and 86.7% in 8-minute asphyxia group respectively (P>0.05). The 6-hour mortality in 8-minute asphyxia group was significantly higher than that in 7-minute asphyxia group (46.7% vs. 6.7%, P0.05). (2) There was a variety of organ dysfunctions in survived rabbits after ROSC, including chemosis, respiratory distress, hypotension, abdominal distension, weakened or disappearance of bowel peristalsis and oliguria. (3) There was no SIRS or associated changes in major organ function in the sham group. SIRS was observed at 12 - 24 hours after ROSC in the two asphyxia groups. CK-MB was increased significantly at 12 hours after ROSC compared with that before asphyxia (7-minute asphyxia group: 786.88±211.84 U/L vs. 468.20±149.45 U/L, 8

  18. Training aids for instruction in the initial management of injury casualties and in resuscitation procedures.

    Science.gov (United States)

    Klausner, J M; Lelcuk, S; Gutman, M; Khazam, A; Rozin, R R

    1987-03-01

    Practical experience in the initial treatment of injured patients is not easily available to the medical student. The small number of injured patients available for observation in a short time, the fact that the patients do not necessarily arrive in regular teaching hours, and the large number of students present in teaching groups compound this difficulty. Specialized instruction in these subjects is therefore important. The acquisition and use of teaching aids facilitate precise and efficient presentation of the material. We present teaching aids specifically prepared for instruction in the initial management of the injured and in resuscitation procedures. These aids include a library of video recordings documenting important emergency procedures, a TV camera used for filming these procedures, a collection of slides on the subject of emergency medicine and recent injuries, mannequins for instruction in cardiopulmonary resuscitation (CPR), utilization of the hospital's animal research laboratory for instruction in critical procedures such as venous cutdown, chest drainage, etc., and simulated computer programs.

  19. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure.

    Science.gov (United States)

    Wenzel, V; Idris, A H; Banner, M J; Kubilis, P S; Band, R; Williams, J L; Lindner, K H

    1998-08-01

    The purpose of the present study was to evaluate respiratory system compliance after cardiopulmonary resuscitation (CPR) and subsequent stomach inflation. Further, we calculated peak airway pressure according to the different tidal volume recommendations of the European Resuscitation Council (7.5 ml/kg) and the American Heart Association (15 ml/kg) for ventilation of an unintubated cardiac arrest victim. After 4 min of ventricular fibrillation, and 6 min of CPR, return of spontaneous circulation (ROSC) after defibrillation occurred in seven pigs. Respiratory system compliance was measured at prearrest, after ROSC, and after 2 and 4 l of stomach inflation in the postresuscitation phase; peak airway pressure was subsequently calculated. Before cardiac arrest the mean (+/- S.D.) respiratory system compliance was 30 +/- 3 ml/cm H2O, and decreased significantly (P CPR and subsequent induction of stomach inflation in an animal model with a wide open airway. This may have a significant impact on peak airway pressure and distribution of gas during ventilation of an unintubated patient with cardiac arrest.

  20. Comparison of the Mapleson C system and adult and paediatric self-inflating bags for delivering guideline-consistent ventilation during simulated adult cardiopulmonary resuscitation.

    Science.gov (United States)

    Sherren, P B; Lewinsohn, A; Jovaisa, T; Wijayatilake, D S

    2011-07-01

    There is a discrepancy between resuscitation teaching and witnessed clinical practice. Furthermore, deleterious outcomes are associated with hyperventilation. We therefore conducted a manikin-based study of a simulated cardiac arrest to evaluate the ability of three ventilating devices to provide guideline-consistent ventilation. Mean (SD) minute ventilation was reduced with the paediatric self-inflating bag (7.0 (3.2) l.min⁻¹) compared with the Mapleson C system (9.8 (3.5) l.min⁻¹) and adult self-inflating bag (9.7 (4.2) l.min⁻¹ ; p = 0.003). Tidal volume was also lower with the paediatric self-inflating bag (391 (52) ml) compared with the others (582 (87) ml and 625 (103) ml, respectively; p < 0.001), as was peak airway pressure (14.5 (5.2) cmH₂O vs 20.7 (9.0) cmH₂O and 30.3 (11.4) cmH₂O, respectively; p < 0.001). Participants hyperventilated patients' lungs in simulated cardiac arrest with all three devices. The paediatric self-inflating bag delivered the most guideline-consistent ventilation. Its use in adult cardiopulmonary resuscitation may ensure delivery of more guideline-consistent ventilation in patients with tracheal intubation. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  1. Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia.

    Science.gov (United States)

    Li, Elliott S; Görens, Immanuel; Cheung, Po-Yin; Lee, Tze-Fun; Lu, Min; O'Reilly, Megan; Schmölzer, Georg M

    2017-01-01

    Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants. © 2017 S. Karger AG, Basel.

  2. Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: Does stress have an influence?

    NARCIS (Netherlands)

    Krage, R. (Ralf); L. Zwaan (Laura); Tjon Soei Len, L. (Lian); Kolenbrander, M.W. (Mark W); Van Groeningen, D. (DIck); S.A. Loer (Stephan A.); C. Wagner (Cordula); P. Schober (P.)

    2017-01-01

    textabstractBackground Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary

  3. A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.

    Science.gov (United States)

    Garibaldi, Brian Thomas; Niessen, Timothy; Gelber, Allan Charles; Clark, Bennett; Lee, Yizhen; Madrazo, Jose Alejandro; Manesh, Reza Sedighi; Apfel, Ariella; Lau, Brandyn D; Liu, Gigi; Canzoniero, Jenna VanLiere; Sperati, C John; Yeh, Hsin-Chieh; Brotman, Daniel J; Traill, Thomas A; Cayea, Danelle; Durso, Samuel C; Stewart, Rosalyn W; Corretti, Mary C; Kasper, Edward K; Desai, Sanjay V

    2017-10-06

    Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

  4. How ABBA may help improve neonatal resuscitation training: auditory prompts to enable coordination of manual inflations and chest compressions.

    Science.gov (United States)

    Roehr, Charles Christoph; Schmölzer, Georg M; Thio, Marta; Dawson, Jennifer A; Dold, Simone Katrin; Schmalisch, Gerd; Davis, Peter G

    2014-06-01

    Resuscitation guidelines recommend 90 chest compressions (CCs) and 30 inflations (INFs) per minute for neonatal cardiopulmonary resuscitation (nCPR). We hypothesised that auditory prompts would help coordinate these actions. Our aim was to investigate the effect of musical prompts during nCPR training on adherence to recommended CC and INF rates and on the quality of delivered INFs. A simulation study was conducted employing 30 experienced neonatal staff, a respiratory function monitor and a neonatal manikin. The effects of five different auditory prompts on adherence to recommended rates of CC and INF were tested against baseline (no music). The five auditory prompts (popular musical tunes) were investigated in random order. Quality of INFs was assessed by comparing the peak inflation pressures (PIP), positive end-expiratory pressures (PEEP), percentage mask leak and tidal volumes (VT). Mean baseline rates at which CCs and INFs were delivered were 80 (SD 6) per minute and 28 (SD 2) per minute, respectively. Listening to auditory prompts had varying effects on CC and INF delivery rates. For CCs, a significant difference to baseline was found only when participants listened to ABBA's 'SOS', with 86 (SD 7) per minute (P = 0.04). For INFs, we found a statistically significant improvement to baseline rate only for 'SOS', with 29 (SD 2) per minute (P = 0.04), and there was no significant difference in INF quality among the auditory prompts. Musical prompts can help with adherence to recommended CC and INF rates but do not improve the quality of INFs during nCPR training. The lasting effect of auditory prompts as musical mnemonics on nCPR performance in vivo needs to be established. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  5. Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping.

    Directory of Open Access Journals (Sweden)

    Ariane Plaisance

    Full Text Available Upon admission to an intensive care unit (ICU, all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR. Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients.To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose.We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR prediction rule calculator.We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5 of the patients involved in the last cycle still did not understand its purpose.Wikis and user-centered design can be used to adapt decision aids to users' needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in

  6. Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping.

    Science.gov (United States)

    Plaisance, Ariane; Witteman, Holly O; LeBlanc, Annie; Kryworuchko, Jennifer; Heyland, Daren Keith; Ebell, Mark H; Blair, Louisa; Tapp, Diane; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; McGinn, Carrie Anna; Légaré, France; Archambault, Patrick Michel

    2018-01-01

    Upon admission to an intensive care unit (ICU), all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose. We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR) prediction rule calculator. We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5) of the patients involved in the last cycle still did not understand its purpose. Wikis and user-centered design can be used to adapt decision aids to users' needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in using the

  7. Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Peberdy, Mary Ann; Gluck, Jason A; Ornato, Joseph P; Bermudez, Christian A; Griffin, Russell E; Kasirajan, Vigneshwar; Kerber, Richard E; Lewis, Eldrin F; Link, Mark S; Miller, Corinne; Teuteberg, Jeffrey J; Thiagarajan, Ravi; Weiss, Robert M; O'Neil, Brian

    2017-06-13

    Cardiac arrest in patients on mechanical support is a new phenomenon brought about by the increased use of this therapy in patients with end-stage heart failure. This American Heart Association scientific statement highlights the recognition and treatment of cardiovascular collapse or cardiopulmonary arrest in an adult or pediatric patient who has a ventricular assist device or total artificial heart. Specific, expert consensus recommendations are provided for the role of external chest compressions in such patients. © 2017 American Heart Association, Inc.

  8. Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2013-01-01

    Survival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted media...... campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased....

  9. Family Presence During Resuscitation: A Double-Edged Sword.

    Science.gov (United States)

    Hassankhani, Hadi; Zamanzadeh, Vahid; Rahmani, Azad; Haririan, Hamidreza; Porter, Joanne E

    2017-03-01

    To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patient's family during resuscitation in the cultural context of Iran. An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. The interviews were audio recorded and semistructured, and were transcribed verbatim. Van Manen's technique was used for data analysis. Two major themes and 10 subthemes emerged, including destructive presence (cessation of resuscitation, interference in resuscitation, disruption to the resuscitation team's focus, argument with the resuscitation team, and adverse mental image in the family) and supportive presence (trust in the resuscitation team, collaboration with the resuscitation team, alleviating the family's concern and settling their nerves, increasing the family's satisfaction, and reducing conflict with resuscitation team members). Participants stated that FPDR may work as a double-edged sword for the family and resuscitation team, hurting or preserving quality. It is thus recommended that guidelines be created to protect patients' and families' rights, while considering the positive aspects of the phenomenon for hospitals. A liaison support person would act to decrease family anxiety levels and would be able to de-escalate any potentially aggressive or confrontational events during resuscitation. Well-trained and expert cardiopulmonary resuscitation team members do not have any stress in the presence of family during resuscitation. Resuscitation events tend to be prolonged when family members are allowed to be present. © 2017 Sigma Theta Tau International.

  10. Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia.

    Science.gov (United States)

    Pasquin, Matteo P; Cheung, Po-Yin; Patel, Sparsh; Lu, Min; Lee, Tze-Fun; Wagner, Michael; O'Reilly, Megan; Schmölzer, Georg M

    2018-04-12

    High-quality chest compression is essential during neonatal cardiopulmonary resuscitation (CPR). However, the optimal compression to ventilation ratio (C:V) that should be used during neonatal CPR to optimize coronary and cerebral perfusion while providing adequate ventilation remains unknown. We hypothesized that different C:V ratios (e.g., 2: 1 or 4: 1) will reduce the time to return of spontaneous circulation (ROSC) in severely asphyxiated piglets. Thirty-one newborn piglets (1-4 days old) were anesthetized, intubated, instrumented, and exposed to 50-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into 4 groups: 2: 1 (n = 8), 3: 1 (n = 8), 4: 1 (n = 8) C:V ratio, or a sham group (n = 7). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Thirty-one piglets were included in the study, and there was no difference in the duration of asphyxia or the degree of asphyxiation (as indicated by pH, PaCO2, and lactate) among the different groups. The median (IQR) time to ROSC was similar between the groups with 127 (82-210), 96 (88-126), and 119 (83-256) s in the 2: 1, 3: 1, and 4: 1 C:V ratio groups, respectively (p = 0.67 between groups). Similarly, there was no difference in 100% oxygen requirement or epinephrine administration between the experimental groups. Different C:V ratios resulted in similar ROSC, mortality, oxygen, and epinephrine administration during resuscitation in a porcine model of neonatal asphyxia. © 2018 S. Karger AG, Basel.

  11. Design of a game-based pre-hospital resuscitation training for first responders

    NARCIS (Netherlands)

    Kalz, Marco; Schmitz, Birgit; Biermann, Henning; Klemke, Roland; Ternier, Stefaan; Specht, Marcus

    2013-01-01

    Kalz, M., Schmitz, B., Biermann, H., Klemke, R., Ternier, S., & Specht, M. (2013). Design of a game-based pre-hospital resuscitation training for first responders. In A. Holzinger, M. Ziefle, & V. Glavinić (Eds.), SouthCHI 2013, LNCS 7946 (pp. 363-372). Germany: Springer, Heidelberg.

  12. Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training

    Science.gov (United States)

    Surcouf, Jeffrey W.; Chauvin, Sheila W.; Ferry, Jenelle; Yang, Tong; Barkemeyer, Brian

    2013-01-01

    Background Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. Purpose Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents’ self-confidence and observed performance of adopted best practices in neonatal resuscitation. Methods Each pediatric and medicine–pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. Results Statistically significant pre–post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00–0.03) reflecting knowledge, technical, and non-technical (teamwork) skills. The pre–post gain in overall confidence score was statistically significant (p=0.00). With a maximum possible assessment score of 41, the average pre–post gain was 8.28 and statistically significant (psimulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education. PMID:23522399

  13. Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines.

    Science.gov (United States)

    Doolin, Christopher T; Quinn, Lisa D; Bryant, Lesley G; Lyons, Ann A; Kleinpell, Ruth M

    2011-01-01

    To provide advanced practice nurses (APNs) with the best available evidence for implementation of policies and procedures to allow family presence during cardiopulmonary resuscitation (CPR) in the acute care environment. A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursing credentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework for implementation of formal policies and procedures. Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere. With this evidence-based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes. ©2010 The Author Journal compilation ©2010 American Academy of Nurse Practitioners.

  14. Trained first-responders with an automated external defibrillator: how do they perform in real resuscitation attempts?

    NARCIS (Netherlands)

    de Vries, Wiebe; van Alem, Anouk P.; de Vos, Rien; van Oostrom, Joost; Koster, Rudolph W.

    2005-01-01

    Introduction: The quality of first-responder performance at the end of automated external defibrillator (AED) training may not predict the performance adequately during a real resuscitation attempt. Methods: Between January and December 2000, we evaluated 67 resuscitation attempts in Amsterdam and

  15. Extracorporeal cardiopulmonary resuscitation for breath-holding spells followed by cardiac arrest due to left main coronary artery stenosis.

    Science.gov (United States)

    Ozyilmaz, Isa; Altin, Husnu Fırat; Yildiz, Okan; Erek, Ersin; Ergul, Yakup; Guzeltas, Alper

    2015-06-01

    Non-syndromic congenital supravalvular aortic stenosis (SVAS) leads to ventricular hypertrophy and increased oxygen consumption, and when combined with other factors reduces coronary blood flow, potentially resulting in myocardial ischemia and sudden cardiac death. While the anatomic obstruction of coronary circulation is as common in non-syndromic SVAS as in Williams syndrome, it often remains unacknowledged. Extracorporeal membrane oxygenation (ECMO) is an elective procedure that can be used to support patients with cardiac arrest during diagnosis as a way to reduce cardiopulmonary load in preparation for surgery or further treatment. In this report, we describe the rare case of an infant with severe SVAS and mild valvular pulmonary and left main coronary artery stenosis, as well as breath-holding spells. After multiple cardiac arrests, the infant underwent diagnostic catheter angiography on ECMO and had the pathology surgically corrected. © 2015 Japan Pediatric Society.

  16. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Lovis, Christian; Combescure, Christophe; Haddad, Kevin; Gervaix, Alain; Manzano, Sergio

    2017-08-22

    During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods. The purpose of this study is to determine whether the use of PedAMINES in both university and smaller hospitals reduces medication dosage errors (primary outcome), time to drug preparation (TDP), and time to drug delivery (TDD) (secondary outcomes) during pediatric CPR when compared with conventional preparation methods. This is a multicenter, prospective, randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drug infusion rate table in the preparation of continuous drug infusion. The evaluation setting uses a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin. The study involving 120 certified nurses (sample size) will take place in the resuscitation rooms of 3 tertiary pediatric emergency departments and 3 smaller hospitals. After epinephrine-induced return of spontaneous circulation, nurses will be asked to prepare a continuous infusion of dopamine using either PedAMINES (intervention group) or the infusion table (control group) and then prepare a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral

  17. Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training

    Directory of Open Access Journals (Sweden)

    Jeffrey W. Surcouf

    2013-03-01

    Full Text Available Background: Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. Purpose: Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents’ self-confidence and observed performance of adopted best practices in neonatal resuscitation. Methods: Each pediatric and medicine–pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. Results: Statistically significant pre–post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00–0.03 reflecting knowledge, technical, and non-technical (teamwork skills. The pre–post gain in overall confidence score was statistically significant (p=0.00. With a maximum possible assessment score of 41, the average pre–post gain was 8.28 and statistically significant (p<0.001. Results of the video-based assessments revealed statistically significant performance gains (p<0.0001. Correlation between live and video-based assessments were strong for pre–post training scenario performances (pre: r=0.64, p<0.0001; post: r=0.75, p<0.0001. Conclusions: Results revealed high receptivity to in-situ, simulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education.

  18. The Validity of Cardiopulmonary Resuscitation Skills in the Emergency Department Using Video-Assisted Surveillance: An Iranian Experience

    Directory of Open Access Journals (Sweden)

    Hooman Hossein-Nejad

    2013-06-01

    Full Text Available The present study was designed to evaluate the quality of CPR procedures performed in Tehran’s Rasool-e-Akram Hospital-- the first Emergency Medicine academic center in Iran-using a videotaped real-life (actual CPR technique, with the aim of pointing out the defects and shortcomings in this regard. The performance of the CPR team in the emergency resuscitation room of Rasool-e-Akram Hospital was evaluated through videotaping. In an expert panel in the educational council of the emergency medicine group scored each item, which could be evaluated through videotaping, based on the existing guidelines. Fifty CPRs were videotaped between May to July 2008. From among the 33 CPRs which were recorded from the very first moment, 25 of them were started which the correct procedure, chest compression and ventilation, whereas procedures such as checking for pulse, getting an IV-line or intubation were performed as the first action in the remaining cases. While many believe CPR is performed properly in our center, the present study revealed that the performance is still distant from the desired ideal.

  19. The validity of cardiopulmonary resuscitation skills in the emergency department using video-assisted surveillance: an Iranian experience.

    Directory of Open Access Journals (Sweden)

    Hooman Hossein-Nejad

    2013-06-01

    Full Text Available The present study was designed to evaluate the quality of CPR procedures performed in Tehran's Rasool-e-Akram Hospital-- the first Emergency Medicine academic center in Iran-using a videotaped real-life (actual CPR technique, with the aim of pointing out the defects and shortcomings in this regard. The performance of the CPR team in the emergency resuscitation room of Rasool-e-Akram Hospital was evaluated through videotaping. In an expert panel in the educational council of the emergency medicine group scored each item, which could be evaluated through videotaping, based on the existing guidelines. Fifty CPRs were videotaped between May to July 2008. From among the 33 CPRs which were recorded from the very first moment, 25 of them were started which the correct procedure, chest compression and ventilation, whereas procedures such as checking for pulse, getting an IV-line or intubation were performed as the first action in the remaining cases. While many believe CPR is performed properly in our center, the present study revealed that the performance is still distant from the desired ideal.

  20. Influence of dobutamine on the variables of systemic haemodynamics, metabolism, and intestinal perfusion after cardiopulmonary resuscitation in the rat.

    Science.gov (United States)

    Studer, Wolfgang; Wu, Xianren; Siegemund, Martin; Marsch, Stephan; Seeberger, Manfred; Filipovic, Miodrag

    2005-02-01

    Global left ventricular dysfunction after successful resuscitation from cardiac arrest may be treated successfully with dobutamine but the effects on intestinal perfusion are unknown. In 24 male Sprague-Dawley rats ventricular fibrillation was induced. After 4 min of untreated cardiac arrest, precordial chest compression was performed for 4 min; adrenaline (epinephrine) (90 microg kg(-1)) was injected, followed by defibrillation. Return of spontaneous circulation was achieved in 18 animals, which were allocated to receive saline 0.9% (control group, n = 6), dobutamine at 5 microg kg(-1) min(-1) (n = 6) or dobutamine at 10 microg kg(-1) min(-1) (n = 6). Measurements of haemodynamic variables and intestinal tonometer P(CO2) were made before induction of ventricular fibrillation and 15, 30, 60, and 120 min postresuscitation. At 120 min postresuscitation, mean aortic pressure was 82 +/- 20, 104 +/- 19, and 113 +/- 15 mmHg for the control group, the dobutamine (5 microg kg(-1) min(-1)) group and the dobutamine (10 microg kg(-1) min(-1)) group (P arrest.

  1. Training for thorax diagnostics. Systematic cardiopulmonary image analysis

    International Nuclear Information System (INIS)

    Kirchner, Johannes

    2010-01-01

    The training book on thorax diagnostics using image analysis is supposed to be a supplement to the usual textbooks based on comprehensive experiences of radiologists. The covered issues are the following: heart insufficiency, acute/ chronic bronchitis and pulmonary emphysema; pneumonia and tuberculosis; bronchial carcinoma; lung fibrosis, sarcoidosis and pneumoconiosis, pleural effusion and pneumothorax.

  2. Effect of metronome rates on the quality of bag-mask ventilation during metronome-guided 30:2 cardiopulmonary resuscitation: A randomized simulation study.

    Science.gov (United States)

    Na, Ji Ung; Han, Sang Kuk; Choi, Pil Cho; Shin, Dong Hyuk

    2017-01-01

    Metronome guidance is a feasible and effective feedback technique to improve the quality of cardiopulmonary resuscitation (CPR). The rate of the metronome should be set between 100 to 120 ticks/minute and the speed of ventilation may have crucial effect on the quality of ventilation. We compared three different metronome rates (100, 110, 120 ticks/minute) to investigate its effect on the quality of ventilation during metronome-guided 30:2 CPR. This is a prospective, randomized, crossover observational study using a RespiTrainer○ r . To simulate 30 chest compressions, one investigator counted from 1 to 30 in cadence with the metronome rate (1 count for every 1 tick), and the participant performed 2 consecutive ventilations immediately following the counting of 30. Thirty physicians performed 5 sets of 2 consecutive (total 10) bag-mask ventilations for each metronome rate. Participants were instructed to squeeze the bag over 2 ticks (1.0 to 1.2 seconds depending on the rate of metronome) and deflate the bag over 2 ticks. The sequence of three different metronome rates was randomized. Mean tidal volume significantly decreased as the metronome rate was increased from 110 ticks/minute to 120 ticks/minute (343±84 mL vs. 294±90 mL, P =0.004). Peak airway pressure significantly increased as metronome rate increased from 100 ticks/minute to 110 ticks/minute (18.7 vs. 21.6 mmHg, P =0.006). In metronome-guided 30:2 CPR, a higher metronome rate may adversely affect the quality of bag-mask ventilations. In cases of cardiac arrest where adequate ventilation support is necessary, 100 ticks/minute may be better than 110 or 120 ticks/minute to deliver adequate tidal volume during audio tone guided 30:2 CPR.

  3. Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado

    Science.gov (United States)

    Sasson, Comilla; Haukoos, Jason S.; Ben-Youssef, Leila; Ramirez, Lorenzo; Bull, Sheana; Eigel, Brian; Magid, David J.; Padilla, Ricardo

    2016-01-01

    Study objective Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO. Methods Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript. Results Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR. Conclusion Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented. PMID:25481112

  4. Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.

    Science.gov (United States)

    Kwon, Younghoon; Debaty, Guillaume; Puertas, Laura; Metzger, Anja; Rees, Jennifer; McKnite, Scott; Yannopoulos, Demetris; Lurie, Keith

    2015-10-28

    The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR). Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO2, were measured and compared during each CPR intervention. The lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (-1.6 ± 1.6); ACD-ITD (-3.7 ± 1.5, p ACD); ACD-ITPR (-7.0 ± 1.9, p ACD)] [Ppl decompression (mean ± SE): STD (-6.3 ± 2.2); ACD (-13.0 ± 3.8); ACD-ITD -16.9 ± 3.6, p ACD); ACD-ITPR -18.7 ± 3.5, p ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures. IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

  5. Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado.

    Science.gov (United States)

    Sasson, Comilla; Haukoos, Jason S; Ben-Youssef, Leila; Ramirez, Lorenzo; Bull, Sheana; Eigel, Brian; Magid, David J; Padilla, Ricardo

    2015-05-01

    Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO. Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript. Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR. Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  6. Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: A comparison with SMS-based system notification.

    Science.gov (United States)

    Caputo, Maria Luce; Muschietti, Sandro; Burkart, Roman; Benvenuti, Claudio; Conte, Giulio; Regoli, François; Mauri, Romano; Klersy, Catherine; Moccetti, Tiziano; Auricchio, Angelo

    2017-05-01

    We compared the time to initiation of cardiopulmonary resuscitation (CPR) by lay responders and/or first responders alerted either via Short Message Service (SMS) or by using a mobile application-based alert system (APP). The Ticino Registry of Cardiac Arrest collects all data about out-of-hospital cardiac arrests (OHCAs) occurring in the Canton of Ticino. At the time of a bystander's call, the EMS dispatcher sends one ambulance and alerts the first-responders network made up of police officers or fire brigade equipped with an automatic external defibrillator, the so called "traditional" first responders, and - if the scene was considered safe - lay responders as well. We evaluated the time from call to arrival of traditional first responders and/or lay responders when alerted either via SMS or the new developed mobile APP. Over the study period 593 OHCAs have occurred. Notification to the first responders network was sent via SMS in 198 cases and via mobile APP in 134 cases. Median time to first responder/lay responder arrival on scene was significantly reduced by the APP-based system (3.5 [2.8-5.2]) compared to the SMS-based system (5.6 [4.2-8.5] min, p 0.0001). The proportion of lay responders arriving first on the scene significantly increased (70% vs. 15%, p<0.01) with the APP. Earlier arrival of a first responder or of a lay responder determined a higher survival rate. The mobile APP system is highly efficient in the recruitment of first responders, significantly reducing the time to the initiation of CPR thus increasing survival rates. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  7. Hands-on defibrillation has the potential to improve the quality of cardiopulmonary resuscitation and is safe for rescuers-a preclinical study.

    Science.gov (United States)

    Neumann, Tobias; Gruenewald, Matthias; Lauenstein, Christoph; Drews, Tobias; Iden, Timo; Meybohm, Patrick

    2012-10-01

    Recently, it has been demonstrated that rescuers could safely provide a low, static downward force in direct contact with patients during elective cardioversion. The purpose of our experimental study was to investigate whether shock delivery during uninterrupted chest compressions may have an impact on cardiopulmonary resuscitation (CPR) quality and can be safely performed in a realistic animal model of CPR. Twenty anesthetized swine were subjected to 7 minutes of ventricular fibrillation followed by CPR according to the 2010 American Heart Association Guidelines. Pregelled self-adhesive defibrillation electrodes were attached onto the torso in the ventrodorsal direction and connected to a biphasic defibrillator. Animals were randomized either to (1) hands-on defibrillation, where rescuers wore 2 pairs of polyethylene gloves and shocks were delivered during ongoing chest compressions, or (2) hands-off defibrillation, where hands were taken off during defibrillation. CPR was successful in 9 out of 10 animals in the hands-on group (versus 8 out of 10 animals in the hands-off group; not significant). In the hands-on group, chest compressions were interrupted for 0.8% [0.6%; 1.4%] of the total CPR time (versus 8.2% [4.2%; 9.0%]; P=0.0003), and coronary perfusion pressure was earlier restored to its pre-interruption level (P=0.0205). Also, rescuers neither sensed any kind of electric stimulus nor did Holter ECG reveal any serious cardiac arrhythmia. Hands-on defibrillation may improve CPR quality and could be safely performed during uninterrupted chest compressions in our standardized porcine model.

  8. Hands-On Defibrillation Has the Potential to Improve the Quality of Cardiopulmonary Resuscitation and Is Safe for Rescuers—A Preclinical Study

    Science.gov (United States)

    Neumann, Tobias; Gruenewald, Matthias; Lauenstein, Christoph; Drews, Tobias; Iden, Timo; Meybohm, Patrick

    2012-01-01

    Background Recently, it has been demonstrated that rescuers could safely provide a low, static downward force in direct contact with patients during elective cardioversion. The purpose of our experimental study was to investigate whether shock delivery during uninterrupted chest compressions may have an impact on cardiopulmonary resuscitation (CPR) quality and can be safely performed in a realistic animal model of CPR. Methods and Results Twenty anesthetized swine were subjected to 7 minutes of ventricular fibrillation followed by CPR according to the 2010 American Heart Association Guidelines. Pregelled self-adhesive defibrillation electrodes were attached onto the torso in the ventrodorsal direction and connected to a biphasic defibrillator. Animals were randomized either to (1) hands-on defibrillation, where rescuers wore 2 pairs of polyethylene gloves and shocks were delivered during ongoing chest compressions, or (2) hands-off defibrillation, where hands were taken off during defibrillation. CPR was successful in 9 out of 10 animals in the hands-on group (versus 8 out of 10 animals in the hands-off group; not significant). In the hands-on group, chest compressions were interrupted for 0.8% [0.6%; 1.4%] of the total CPR time (versus 8.2% [4.2%; 9.0%]; P=0.0003), and coronary perfusion pressure was earlier restored to its pre-interruption level (P=0.0205). Also, rescuers neither sensed any kind of electric stimulus nor did Holter ECG reveal any serious cardiac arrhythmia. Conclusions Hands-on defibrillation may improve CPR quality and could be safely performed during uninterrupted chest compressions in our standardized porcine model. PMID:23316286

  9. Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.

    Science.gov (United States)

    Stipulante, Samuel; Tubes, Rebecca; El Fassi, Mehdi; Donneau, Anne-Francoise; Van Troyen, Barbara; Hartstein, Gary; D'Orio, Vincent; Ghuysen, Alexandre

    2014-02-01

    Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation. At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09). From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. The effects of calcium and sodium bicarbonate on severe hyperkalaemia during cardiopulmonary resuscitation: A retrospective cohort study of adult in-hospital cardiac arrest.

    Science.gov (United States)

    Wang, Chih-Hung; Huang, Chien-Hua; Chang, Wei-Tien; Tsai, Min-Shan; Yu, Ping-Hsun; Wu, Yen-Wen; Hung, Kuan-Yu; Chen, Wen-Jone

    2016-01-01

    Calcium and sodium bicarbonate (SB) are frequently used in treating patients with severe hyperkalaemia. We evaluated the efficacy of these medications for the treatment of severe hyperkalaemia during cardiopulmonary resuscitation (CPR). We also hypothesised that the effects of these medications might be associated with serum potassium level during CPR. We conducted a retrospective observational study in a single medical centre. From adult patients who had suffered an in-hospital cardiac arrest from 2006 through 2012, we included those with a serum potassium level>6.5 mEq/L measured during CPR. We used multivariable logistic regression analysis to study the association of calcium/SB with sustained return of spontaneous circulation (ROSC). Among the 109 patients included in our analysis, 40 (36.7%) patients achieved sustained ROSC, and only four (3.7%) patients survived to hospital discharge. The mean serum potassium level was 7.8 mEq/L. The analysis indicated that administration of SB was positively associated with sustained ROSC when serum potassium level was <7.9 mEq/L (odds ratio [OR]: 10.51; 95% confidence interval [CI]: 1.50-112.89; p: 0.03); administration of calcium and SB was also positively associated with sustained ROSC when serum potassium level was <9.4 mEq/L (OR: 51.11; 95% CI: 3.12-1639.16; p: 0.01). The use of calcium and SB might be effective in the treatment of severe hyperkalaemia during cardiac arrest. The efficacy of SB/calcium correlated with serum potassium level. However, because the number of patients included in the analysis was small, this conclusion should be further examined in the future. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. The design of instructional tools affects secondary school students' learning of cardiopulmonary resuscitation (CPR) in reciprocal peer learning: a randomized controlled trial.

    Science.gov (United States)

    Iserbyt, Peter; Byra, Mark

    2013-11-01

    Research investigating design effects of instructional tools for learning Basic Life Support (BLS) is almost non-existent. To demonstrate the design of instructional tools matter. The effect of spatial contiguity, a design principle stating that people learn more deeply when words and corresponding pictures are placed close (i.e., integrated) rather than far from each other on a page was investigated on task cards for learning Cardiopulmonary Resuscitation (CPR) during reciprocal peer learning. A randomized controlled trial. A total of 111 students (mean age: 13 years) constituting six intact classes learned BLS through reciprocal learning with task cards. Task cards combine a picture of the skill with written instructions about how to perform it. In each class, students were randomly assigned to the experimental group or the control. In the control, written instructions were placed under the picture on the task cards. In the experimental group, written instructions were placed close to the corresponding part of the picture on the task cards reflecting application of the spatial contiguity principle. One-way analysis of variance found significantly better performances in the experimental group for ventilation volumes (P=.03, ηp2=.10) and flow rates (P=.02, ηp2=.10). For chest compression depth, compression frequency, compressions with correct hand placement, and duty cycles no significant differences were found. This study shows that the design of instructional tools (i.e., task cards) affects student learning. Research-based design of learning tools can enhance BLS and CPR education. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    obligation to act. CONCLUSIONS: Several factors other than previous hands-on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out-of-hospital cardiac arrest....... factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders......, until data saturation. We used cross-sectional indexing (using software), and inductive in-depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands-on CPR training, the following were described as facilitators: prior knowledge that intervention...

  13. Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær

    2017-01-01

    AND RESULTS: A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed...

  14. Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university

    OpenAIRE

    Boaventura, Ana Paula; Miyadahira, Ana Maria Kazue

    2012-01-01

    A desfibrilação precoce na ressuscitação cardiopulmonar (RCP) recebe crescente destaque quanto à prioridade e rapidez. Este é um relato de experiência da implantação de um programa de capacitação em RCP, utilizando o desfibrilador em uma universidade privada. O programa em manobras básicas de RCP foi baseado nas diretrizes mundiais, envolvendo um curso teórico com demonstração prática das manobras de RCP com desfibrilador, treinamento prático individual, avaliação teórica e prática. Quanto ao...

  15. Tele-education vs classroom training of neonatal resuscitation: a randomized trial.

    Science.gov (United States)

    Jain, A; Agarwal, R; Chawla, D; Paul, V; Deorari, A

    2010-12-01

    To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching. This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n=26) or classroom teaching (CT, n=22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods. Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3±1.7 vs 6.6±1.4, P=0.004). However, skill scores were comparable in the two groups (11.7±3 vs 10.3±2.9, P=0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2±2.2 vs 5.3±1.7; P=0.06) and skills scores (4.5±3.3 vs 5.0±3.1, P=0.62) in both the groups. The post-training knowledge scores (TI: 12.5±1.7 vs CT: 12.0±1.7, P=0.37) and the post-training skill scores (TI: 16.0±0.5 vs CT: 15.6±2.5, P=0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46±0.03 vs 12.16±0.01, P=0.00; skills: 15.6±2.5 vs 16.0±2.8, P=0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups. Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.

  16. Effect of exercise training on cardiopulmonary baroreflex control of forearm vascular resistance in humans

    Science.gov (United States)

    Mack, G. W.; Convertino, V. A.; Nadel, E. R.

    1993-01-01

    We studied the stimulus-response characteristics of cardiopulmonary baroreflex control of forearm vascular resistance (FVR) in four groups of male volunteer subjects: i) unfit, ii) physically fit, iii) before and after 10 wk of endurance training (chronic blood volume expansion), and iv) before and after acute blood volume expansion. We assessed the relationship between reflex stimulus, i.e., changes in central venous pressure and response, i.e., FVR, during unloading of cardiopulmonary mechanoreceptors with lower body negative pressure (LBNP, 0 to -20 mm Hg). The slope of the linear relationship between FVR and CVP, the index of the responsiveness of this baroreflex, was significantly diminished (> 50%) in the fit subjects compared with the unfit. The slope of the FVR-CVP relationship was inversely correlated with the subject's total blood volume, suggesting that blood volume expansion was related to the attenuated CP baroreflex. In the exercise training study, maximal oxygen consumption and blood volume increased following 10 wk of endurance training (N = 14) but were unchanged in the time control group (N = 7). The slope of the FVR-CVP relationship was significantly reduced (32%) following 10 wk of training but was unchanged in the time control group. The reduction in slope of the FVR-CVP relationship was inversely related to the increase in blood volume associated with exercise training. Acute blood volume expansion 8 ml.kg-1 body weight with 5% human serum albumin solution) significantly reduced the slope of the FVR-CVP relationship. These data support the hypothesis that the attenuated forearm vascular reflex in physically fit individuals is related to a training-induced hypervolemia.(ABSTRACT TRUNCATED AT 250 WORDS).

  17. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    Science.gov (United States)

    Siebert, Johan N; Ehrler, Frederic; Combescure, Christophe; Lacroix, Laurence; Haddad, Kevin; Sanchez, Oliver; Gervaix, Alain; Lovis, Christian; Manzano, Sergio

    2017-02-01

    During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and

  18. Age, sex, and hospital factors are associated with the duration of cardiopulmonary resuscitation in hospitalized patients who do not experience sustained return of spontaneous circulation.

    Science.gov (United States)

    Khan, Abigail M; Kirkpatrick, James N; Yang, Lin; Groeneveld, Peter W; Nadkarni, Vinay M; Merchant, Raina M

    2014-12-01

    Variability in the duration of attempted in‐hospital cardiopulmonary resuscitation (CPR) is high, but the factors influencing termination of CPR efforts are unknown. We examined the association between patient and hospital characteristics and CPR duration in 45 500 victims of in‐hospital cardiac arrest who did not experience return of spontaneous circulation (ROSC) and who were enrolled in the Get With the Guidelines registry between 2001 and 2010. In a secondary analysis, we performed analyses in 46 168 victims of in‐hospital cardiac arrest who experienced ROSC. We used ordered logistic regression to identify factors associated with CPR duration. Analyses were conducted by tertile of CPR duration (tertiles: ROSC group: 2 to 7, 8 to 17, and 18 to 120 minutes; no‐ROSC group: 2 to 16, 17 to 26, 27 to 120 minutes). In those without ROSC, younger age (aged 18 to 40 versus >65 years; odds ratio [OR] 1.81; 95% CI 1.69 to 1.95; P<0.001), female sex (OR 1.05; 95% CI 1.02 to 1.09; P=0.005), ventricular tachycardia or fibrillation (OR 1.50; 95% CI 1.42 to 1.58; P<0.001), and the need to place an invasive airway (OR 2.59; 95% CI 2.46 to 2.72; P<0.001) were associated with longer CPR duration. In those with ROSC, ventricular tachycardia or fibrillation (OR 0.89; 95% CI 0.85 to 0.93; P<0.001) and witnessed events (OR 0.87; 95% CI 0.82 to 0.91; P<0.001) were associated with shorter duration. Age and sex were associated with attempted CPR duration in patients who do not experience ROSC after in‐hospital cardiac arrest but not in those who experience ROSC. Understanding the mechanism of these interactions may help explain variability in outcomes for in‐hospital cardiac arrest.

  19. Quality of audio-assisted versus video-assisted dispatcher-instructed bystander cardiopulmonary resuscitation: A systematic review and meta-analysis.

    Science.gov (United States)

    Lin, Yu-You; Chiang, Wen-Chu; Hsieh, Ming-Ju; Sun, Jen-Tang; Chang, Yi-Chung; Ma, Matthew Huei-Ming

    2018-02-01

    This study aimed to conduct a systematic review and meta-analysis comparing the effect of video-assistance and audio-assistance on quality of dispatcher-instructed cardiopulmonary resuscitation (DI-CPR) for bystanders. Five databases were searched, including PubMed, Cochrane library, Embase, Scopus and NIH clinical trial, to find randomized control trials published before June 2017. Qualitative analysis and meta-analysis were undertaken to examine the difference between the quality of video-instructed and audio-instructed dispatcher-instructed bystander CPR. The database search yielded 929 records, resulting in the inclusion of 9 relevant articles in this study. Of these, 6 were included in the meta-analysis. Initiation of chest compressions was slower in the video-instructed group than in the audio-instructed group (median delay 31.5 s; 95% CI: 10.94-52.09). The difference in the number of chest compressions per minute between the groups was 19.9 (95% CI: 10.50-29.38) with significantly faster compressions in the video-instructed group than in the audio-instructed group (104.8 vs. 80.6). The odds ratio (OR) for correct hand positioning was 0.8 (95% CI: 0.53-1.30) when comparing the audio-instructed and video-instructed groups. The differences in chest compression depth (mm) and time to first ventilation (seconds) between the video-instructed group and audio-instructed group were 1.6 mm (95% CI: -8.75, 5.55) and 7.5 s (95% CI: -56.84, 71.80), respectively. Video-instructed DI-CPR significantly improved the chest compression rate compared to the audio-instructed method, and a trend for correctness of hand position was also observed. However, this method caused a delay in the commencement of bystander-initiated CPR in the simulation setting. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

    NARCIS (Netherlands)

    Perkins, Gavin D.; Jacobs, Ian G.; Nadkarni, Vinay M.; Berg, Robert A.; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L.; Brett, Stephen J.; Chamberlain, Douglas; de Caen, Allan R.; Deakin, Charles D.; Finn, Judith C.; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W.; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F.; Morley, Peter T.; Morrison, Laurie J.; Monsieurs, Koenraad G.; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H.; Nolan, Jerry P.; Aikin, Richard P.; Böttiger, Bernd W.; Callaway, Clifton W.; Castren, Maaret K.; Eisenberg, Mickey S.; Kleinman, Monica E.; Kloeck, David A.; Kloeck, Walter G.; Mancini, Mary E.; Neumar, Robert W.; Ornato, Joseph P.; Paiva, Edison F.; Peberdy, Mary Ann; Soar, Jasmeet; Sierra, Alfredo F.; Stanton, David; Zideman, David A.; Rea, Thomas

    2015-01-01

    Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and

  1. Ruptura gástrica por reanimação cardiopulmonar: relato de caso Gastric rupture following cardiopulmonary resuscitation: case report

    Directory of Open Access Journals (Sweden)

    Lucas Teixeira Dias

    2006-06-01

    cardiopulmonary resuscitation (CPR, with a reported incidence of 0.1%. Unawareness of this possible complication during these maneuvers delays its recognition and reduces the patient’s surviving chance. The aim of this report is to describe a case of acute abdomen due to gastric rupture following CPR maneuvers that was promptly diagnosed and treated. CASE REPORT: We report a case of a 76-year-old patient that was admitted to the hospital with pneumonia and also to rule out a possible brain vascular accident (BVA. In the first day after admission she developed acute respiratory failure and cardiac arrest, being successfully resuscitated and subsequently transferred to the intensive care unit (ICU by the medical ward team. Despite successful CPR, adequate volume resuscitation, vasopressor support and respiratory function improvement she remained with significant hemodynamic instability. Physical examination hours after CPR showed a hypertimpanic liver percussion, abdominal distension, tachycardia and hypotension. Chest X-Ray revealed pneumoperitoneum, and gastric perforation was identified by an exploratory laparotomy. Histopathology confirmed traumatic gastric injury. CONCLUSIONS: We report a rare case of traumatic gastric rupture after CPR maneuvers in which prompt diagnosis and emergent treatment lead to a favorable outcome. This case brings out the need to increase awareness of this life-threatening complication with emphasis on the importance of a thorough physical examination after CPR maneuvers. Reinforcement of appropriate CPR technique is crucial to avoid incorrect maneuvers through continued medical education.

  2. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  3. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma.

    Science.gov (United States)

    Dalle Ave, Anne L; Shaw, David M; Gardiner, Dale

    2016-11-01

    The availability of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (E-CPR), for use in refractory out-of hospital cardiac arrest (OHCA), is increasing. In parallel, some countries have developed uncontrolled donation after circulatory determination of death (uDCDD) programs using ECMO to preserve organs for transplantation purposes. When facing a refractory OHCA, how does the medical team choose between initiating ECMO as part of an E-CPR protocol or ECMO as part of a uDCDD protocol? To answer these questions we conducted a literature review on E-CPR compared to uDCDD protocols using ECMO and analyzed the raised ethical issues. Our analysis reveals that the inclusion criteria in E-CPR and uDCDD protocols are similar. There may be a non-negligible risk of including patients in a uDCDD protocol, when the patient might have been saved by the use of E-CPR. In order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uDCDD protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uDCDD programs, (4) E-CPR should be clinically considered first before the initiation of any uDCDD protocol, and (5) there should be no discrimination in the availability of access to E-CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The role of cardiopulmonary exercise test for individualized exercise training recommendation in young obese subjects

    Directory of Open Access Journals (Sweden)

    Lucian Hoble

    2010-06-01

    Full Text Available Obesity is affecting a growing segment of the population and should be considered a serious health problem which will lead to medical complications and decreased life span. Lifestyle changes by adopting healthy food and increase energy consumption through physical activity is the most important treatment for obesity. Cardiopulmonary exercise test (CPET is considered the gold standard for exercise capacity assessment. Purpose: This study is aiming to demonstrate that individualized exercise training programs, designed using CPET results, leads to increase of physical fitness, aerobic capacity, ventilatory and cardiac exercise performance in young obese subjects.Material and method:We performed a prospective research study of 6 months. 43 sedentary subjects without contraindications to exercise, 21.3±3.1 years old, 93% female were included in the study. Assessments were made at baseline and after six months of intervention and consists of cardiopulmonary exercise test on bicycle ergometer. After we recorded oxygen uptake at aerobic threshold (AT, anaerobic threshold (in the range of respiratory compensation point – RCP and maximal oxygen uptake (VO2max we designed the training program according to these parameters and individualized heart rate training zones of each subject. Exercise training (60 minutes/session, 3 sessions/week was performed taking in consideration the training zones and using a circuit on cardio devices. Each subject was supervised by a physiotherapist and using heart rate monitors. The number of subjects evaluated at the end of the study was 27 (dropout rate 37%.Results:After six months of intervention we noticed an improvement of maximum oxygen uptake (VO2max (from 22.7±3.69 to 27.44±5.55, aerobic threshold (VO2_AT (from 15.48±2.66 to 20.07±4.64 ml/min/kg, p<0.0001 and anaerobic threshold (VO2_RCP (from 20.3±3.66 to 25.11±5.84 ml/min/kg, p<0.0001, cardiac performance during exercise evaluated trough maximal oxygen

  5. Advanced Cardiac Resuscitation Evaluation (ACRE: A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

    Directory of Open Access Journals (Sweden)

    Hughes Thomas C

    2010-01-01

    Full Text Available Abstract Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE. The checklist items were based on International Liaison Committee on Resuscitation (ILCOR guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98% of students from the expert-led group achieved a Pass compared to 72/74 (97% from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001 that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49% of students: 33/58 (57% from the expert-led group, 31/74 (42% from the peer-led group. Exact

  6. Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study.

    Science.gov (United States)

    Chang, Won Hyuk; Kim, Min Su; Huh, Jung Phil; Lee, Peter K W; Kim, Yun-Hee

    2012-05-01

    . Robot-assisted gait training has the potential to improve cardiopulmonary fitness after stroke, even for patients who are in the early stages of recovery and not independent ambulators. The authors compared the effects of robot-assisted gait training and conventional physical therapy on cardiopulmonary fitness. . A prospective single-blinded, randomized controlled study of 37 patients receiving inpatient rehabilitation was performed within 1 month after stroke onset. The robot-assisted gait training group (n = 20) received 40 minutes of gait training with Lokomat and 60 minutes of conventional physical therapy each day, whereas the control group (n = 17) received 100 minutes of conventional physical therapy daily. Using a semirecumbent cycle ergometer, changes in cardiopulmonary fitness were investigated using incremental exercise testing. Motor and gait functional recovery was measured according to changes in the lower-extremity score of the Fugl-Meyer Assessment Scale (FMA-L), leg score of the Motricity Index (MI-L), and the Functional Ambulation Category (FAC). . Compared with the control group, the robot group showed 12.8% improvement in peak VO(2) after training (P fitness in patients who are not yet independent ambulators, but that may require more than 2 weeks of continued, progressive training.

  7. Effect of Emergency Department Mattress Compressibility on Chest Compression Depth Using a Standardized Cardiopulmonary Resuscitation Board, a Slider Transfer Board, and a Flat Spine Board: A Simulation-Based Study.

    Science.gov (United States)

    Cheng, Adam; Belanger, Claudia; Wan, Brandi; Davidson, Jennifer; Lin, Yiqun

    2017-12-01

    Cardiopulmonary resuscitation (CPR) performed on a mattress decreases effective chest compression depth. Using a CPR board partially attenuates mattress compressibility. We aimed to determine the effect of a CPR board, a slider transfer board, a CPR board with a slider transfer board, and a flat spine board on chest compression depth with a mannequin placed on an emergency department mattress. The study used a cross-over study design. The CPR-certified healthcare providers performed 2 minutes of compressions on a mannequin in five conditions, an emergency department mattress with: (a) no hard surface, (b) a CPR board, (c) a slider transfer board, (d) a CPR board and slider transfer board, and (e) a flat spine board. Compression depths were measured from two sources for each condition: (a) an internal device measuring sternum-to-spine compression and (b) an external device measuring sternum-to-spine compression plus mattress compression. The difference of the two measures (ie, depleted compression depth) was summarized and compared between conditions. A total of 10,203 individual compressions from 10 participants were analyzed. The mean depleted compression depths (percentage depletion) secondary to mattress effect were the following: 23.6 mm (29.7%) on a mattress only, 13.7 mm (19.5%) on a CPR board, 16.9 mm (23.1%) on a slider transfer board, 11.9 mm (17.3%) on a slider transfer board plus backboard, and 10.3 mm (15.4%) on a flat spine board. The differences in percentage depletion across conditions were statistically significant. Cardiopulmonary resuscitation providers should use a CPR board and slider transfer board or a flat spine board alone because these conditions are associated with the smallest amount of mattress compressibility.

  8. Fatores prognósticos de sobrevida pós-reanimação cardiorrespiratória cerebral em hospital geral In-hospital post-cardiopulmonary-cerebral resuscitation survival prognostic factors

    Directory of Open Access Journals (Sweden)

    André Mansur de Carvalho Guanaes Gomes

    2005-10-01

    Full Text Available OBJETIVO: Analisar as características clínicas e demográficas dos pacientes que receberam reanimação cardiorrespiratória e detectar fatores prognósticos de sobrevivência a curto e longo prazo. MÉTODOS: Analisamos, prospectivamente, 452 pacientes que receberam reanimação em hospitais gerais de Salvador. Utilizou-se análise uni, bivariada e estratificada nas associações entre as variáveis e a curva de sobrevida de Kaplan-Meier e a regressão de Cox para análise de nove anos de evolução. RESULTADOS: A idade variou de 14 a 93 anos, media de 54,11 anos; predominou o sexo masculino; metade dos pacientes tinha ao menos uma doença de base, enfermidade cardiovascular foi etiologia responsável em metade dos casos. Parada cardíaca foi testemunhada em 77% dos casos e em apenas 69% dos pacientes foi iniciada imediatamente a reanimação. O ritmo cardíaco inicial não foi diagnosticado em 59% dos pacientes. Assistolia foi o ritmo mais freqüente (42%, seguida de arritmia ventricular (35%. A sobrevida imediata foi de 24% e sobrevida à alta hospitalar de 5%. Foram identificados como fatores prognósticos em curto prazo: etiologia da parada; diagnóstico do ritmo cardíaco inicial; fibrilação ou taquicardia ventricular como mecanismo de parada; tempo estimado préreanimação menor ou igual a 5 minutos e, tempo de reanimação menor ou igual a 15 minutos. Os fatores prognósticos de sobrevivência em nove anos de evolução foram: não ter recebido epinefrina; ser reanimado em hospital privado e tempo de reanimação menor ou igual a 15 minutos. CONCLUSÃO: Os dados observados podem servir de subsídios para os profissionais de saúde decidir quando iniciar ou parar uma reanimação no ambiente hospitalar.OBJECTIVE: To assess clinical and demographic characteristics of patients who had cardiopulmonary resuscitation and identify short- and long-term survival prognostic factors. METHODS: Four hundred and fifty-two (452 resuscitated

  9. Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

    NARCIS (Netherlands)

    Dankiewicz, Josef; Friberg, Hans; Bělohlávek, Jan; Walden, Andrew; Hassager, Christian; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hovdenes, Jan; Horn, Janneke; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Thomas; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matthew; Åneman, Anders; Nielsen, Niklas

    2016-01-01

    The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature

  10. Cardiopulmonary function of Young bronchitics (mostly mineworkers) before and after respiratory physiotherapy and physical training. Comparison with a control group

    Energy Technology Data Exchange (ETDEWEB)

    Marcq, M.; Minette, A.

    1981-01-01

    This article covers the effects of 4 weeks' treatment consisting of respiratory physiotherapy associated with physical training on cardiopulmonary function. It involved 12 patients (updated group) suffering from chronic bronchitis, still at an early stage in clinical terms. All patients showed signs of early broncho-destructive problems. This research was carried out with financial aid from the EEC (Agreement No. 7246-30-2-001). (32 refs.)

  11. Electronic learning in advanced resuscitation training: The perspective of the candidate.

    Science.gov (United States)

    Lockey, Andrew S; Dyal, Laura; Kimani, Peter K; Lam, Jenny; Bullock, Ian; Buck, Dominic; Davies, Robin P; Perkins, Gavin D

    2015-12-01

    Studies have shown that blended approaches combining e-learning with face-to-face training reduces costs whilst maintaining similar learning outcomes. The preferences in learning approach for healthcare providers to this new style of learning have not been comprehensively studied. The aim of this study is to evaluate the acceptability of blended learning to advanced resuscitation training. Participants taking part in the traditional and blended electronic advanced life support (e-ALS) courses were invited to complete a written evaluation of the course. Participants' views were captured on a 6-point Likert scale and in free text written comments covering the content, delivery and organisation of the course. Proportional-odds cumulative logit models were used to compare quantitative responses. Thematic analysis was used to synthesise qualitative feedback. 2848 participants from 31 course centres took part in the study (2008-2010). Candidates consistently scored content delivered face-to-face over the same content delivered over the e-learning platform. Candidates valued practical hands on training which included simulation highly. Within the e-ALS group, a common theme was a feeling of "time pressure" and they "preferred the face-to-face teaching". However, others felt that e-ALS "suited their learning style", was "good for those recertifying", and allowed candidates to "use the learning materials at their own pace". The e-ALS course was well received by most, but not all participants. The majority felt the e-learning module was beneficial. There was universal agreement that the face-to-face training was invaluable. Individual learning styles of the candidates affected their reaction to the course materials. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

    Science.gov (United States)

    Travers, Andrew H; Perkins, Gavin D; Berg, Robert A; Castren, Maaret; Considine, Julie; Escalante, Raffo; Gazmuri, Raul J; Koster, Rudolph W; Lim, Swee Han; Nation, Kevin J; Olasveengen, Theresa M; Sakamoto, Tetsuya; Sayre, Michael R; Sierra, Alfredo; Smyth, Michael A; Stanton, David; Vaillancourt, Christian

    2015-10-20

    This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of

  13. 46 CFR 28.210 - First aid equipment and training.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false First aid equipment and training. 28.210 Section 28.210....210 First aid equipment and training. (a) Each vessel must have on board a complete first aid manual... location. (b) First aid and cardiopulmonary resuscitation (CPR) course certification. Certification in...

  14. Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support.

    Science.gov (United States)

    Mendler, Marc R; Weber, Claudia; Hassan, Mohammad A; Huang, Li; Mayer, Benjamin; Hummler, Helmut D

    2017-01-01

    There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP. © 2016 S. Karger AG, Basel.

  15. Respostas cardiopulmonares agudas de mulheres no treinamento de força Acute cardiopulmonary responses of women in strength training

    Directory of Open Access Journals (Sweden)

    Márcio Antônio Gonsalves Sindorf

    2013-02-01

    Full Text Available OBJETIVO: Investigar as respostas cardiopulmonares de uma sessão de treinamento de força em mulheres jovens. MÉTODO: Participaram do estudo 23 mulheres, com idade entre 18 e 29 anos. Todas as voluntárias foram submetidas aos seguintes testes: cardiopulmonar e de uma repetição máxima (1-RM. O protocolo de treinamento de força teve ênfase em hipertrofia muscular, três séries de oito a 12 repetições a 70% de 1-RM, com intervalos de um minuto e 30 segundos entre as séries. Durante a sessão de treinamento foi realizada a medida das variáveis cardiopulmonares por meio de analisador de gases metabólicos e módulo de telemetria. RESULTADOS: Os resultados do consumo de oxigênio da sessão de treinamento foram de 8,43 ± 1,76 ml/kg/min e da frequência cardíaca de 108,08 ± 15,26 bpm. Os resultados do consumo de oxigênio e da frequência cardíaca do treino foram inferiores (p OBJETIVE: Investigate the cardiopulmonary responses of one strength training session in young women. METHOD: Twenty-three women aged between 18 and 29 years participated in this study. All the volunteers were submitted to the following tests: cardiopulmonary and one-repetition maximum (1-RM. The strength training protocol had emphasis on muscular hypertrophy, three sets from eight to twelve repetitions under 70% of 1-RM, with a one minute thirty-second break between sets. During the training session, the cardiopulmonary variables were measured with a metabolic gas analyzer and a telemetry module. RESULTS: The results of the oxygen consumption in the training session were from 8.43 + 1.76 ml/kg/min and of the heart rate of 108.08 + 15.26 bpm. The results of the oxygen consumption and of the heart rate in the training were lower (p < 0.01 than in the ventilatory threshold and of the oxygen consumption and the heart rate reserves. CONCLUSION: The obtained data show that the present protocol of strength training provided low overload to the cardiopulmonary system of

  16. An unsuccessful resuscitation:

    African Journals Online (AJOL)

    Introduction. Resuscitation training focuses on technical skills and little attention is given to breaking bad news when the resuscitation has been unsuc- cessful.1 Most doctors do not really know what the needs of the grieving families are or what they expect from the staff in this time of crisis.2 Many doctors have difficulty ...

  17. Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

    DEFF Research Database (Denmark)

    Dankiewicz, Josef; Friberg, Hans; Bělohlávek, Jan

    2016-01-01

    interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function. CONCLUSIONS: TTM at 33°C compared to 36°C was not associated with an increased......INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain...

  18. Chest compression during sustained inflation versus 3:1 chest compression:ventilation ratio during neonatal cardiopulmonary resuscitation: a randomised feasibility trial.

    Science.gov (United States)

    Schmölzer, Georg M; O Reilly, Megan; Fray, Caroline; van Os, Sylvia; Cheung, Po-Yin

    2017-10-07

    Current neonatal resuscitation guidelines recommend 3:1 compression:ventilation (C:V) ratio. Recently, animal studies reported that continuous chest compressions (CC) during a sustained inflation (SI) significantly improved return of spontaneous circulation (ROSC). The approach of CC during SI (CC+SI) has not been examined in the delivery room during neonatal resuscitation. It is a feasibility study to compare CC+SI versus 3:1 C:V ratio during neonatal resuscitation in the delivery room. We hypothesised that during neonatal resuscitation, CC+SI will reduce the time to ROSC. Our aim was to examine if CC+SI reduces ROSC compared with 3:1 C:V CPR in preterm infants <33 weeks of gestation. Randomised feasibility trial. Once CC was indicated all eligible infants were immediately and randomly allocated to either CC+SI group or 3:1 C:V group. A sequentially numbered, brown, sealed envelope contained a folded card box with the treatment allocation was opened by the clinical team at the start of CC. Infants in the CC+SI group received CC at a rate of 90/min during an SI with a duration of 20 s (CC+SI). After 20 s, the SI was interrupted for 1 s and the next SI was started for another 20 s until ROSC. Infants in the '3:1 group' received CC using 3:1 C:V ratio until ROSC. Overall the mean (SD) time to ROSC was significantly shorter in the CC+SI group with 31 (9) s compared with 138 (72) s in the 3:1 C:V group (p=0.011). CC+SI is feasible in the delivery room. Clinicaltrials.gov NCT02083705, pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. [The concept of training anesthesia-resuscitation specialists for high-technology medical aid-delivering health care facilities].

    Science.gov (United States)

    Subbotin, V V; Sitnikov, A V; Il'in, S A

    2009-01-01

    The paper presents the concept of training specialists in anesthesia-resuscitation for high-technology-delivering facilities. This concept is based on the module-axial type of education based on two basic principles: from complex to simple (from general to particular) (the so-called axis) and the modular organization of an educational process. Education implies the obligatory teaching of the axis (the structuring of the already available knowledge) and specialized programs (modules) are incorporated into a course of subjects if there is a practical need, which permits a student to achieve the necessary level of knowledge and skills.

  20. High-fidelity medical simulation training improves medical students' knowledge and confidence levels in septic shock resuscitation

    Directory of Open Access Journals (Sweden)

    Vattanavanit V

    2016-12-01

    Full Text Available Veerapong Vattanavanit, Jarernporn Kawla-ied, Rungsun Bhurayanontachai Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand Background: Septic shock resuscitation bundles have poor compliance worldwide partly due to a lack of knowledge and clinical skills. High-fidelity simulation-based training is a new teaching technology in our faculty which may improve the performance of medical students in the resuscitation process. However, since the efficacy of this training method in our institute is limited, we organized an extra class for this evaluation.Purpose: The aim was to evaluate the effect on medical students’ knowledge and confidence levels after the high-fidelity medical simulation training in septic shock management.Methods: A retrospective study was performed in sixth year medical students during an internal medicine rotation between November 2015 and March 2016. The simulation class was a 2-hour session of a septic shock management scenario and post-training debriefing. Knowledge assessment was determined by a five-question pre-test and post-test examination. At the end of the class, the students completed their confidence evaluation questionnaire.Results: Of the 79 medical students, the mean percentage score ± standard deviation (SD of the post-test examination was statistically significantly higher than the pre-test (66.83%±19.7% vs 47.59%±19.7%, p<0.001. In addition, the student mean percentage confidence level ± SD in management of septic shock was significantly better after the simulation class (68.10%±12.2% vs 51.64%±13.1%, p<0.001. They also strongly suggested applying this simulation class to the current curriculum.Conclusion: High-fidelity medical simulation improved the students’ knowledge and confidence in septic shock resuscitation. This simulation class should be included in the curriculum of the sixth year medical students

  1. Cardiopulmonary Collapse during Labour

    Directory of Open Access Journals (Sweden)

    Vasilis Sitras

    2010-01-01

    Full Text Available Cardiopulmonary collapse during labour is a catastrophic event caused by various medical, surgical and obstetrical conditions. It is an emergency that threatens the life of the mother and her unborn child. We present a case of a pregnant woman who suffered from preeclampsia and underwent induction of labour. Severe lung edema occurred early in labour that caused cardiopulmonary collapse. Advanced heart-lung resuscitation was established immediately and continued until an emergency cesarean section was performed few minutes later. The outcome was favourable for both mother and child. We further discuss some aspects of the pathophysiology and appropriate treatment of cardiorespiratory arrest during labour, which involves the coordinated action of the obstetric, pediatric and surgical ward personnel.

  2. Cardiac resuscitation events: one eyewitness is not enough.

    Science.gov (United States)

    Su, Lillian; Waller, Mary; Kaplan, Seth; Watson, Anne; Jones, Melissa; Wessel, David L

    2015-05-01

    To determine the accuracy of paper cardiopulmonary resuscitation records. Case series. Twenty-six-bed video-monitored pediatric cardiac ICU. All patients who had a resuscitation event with available video and electronically stored vital sign and waveform data from May 2012 to February 2013. None. There were 41 cardiopulmonary resuscitation events during the study period. Fifteen had complete and valid data from the paper cardiopulmonary resuscitation forms, the retrieved monitor data, and the continuous bedside video monitoring. These 15 events occurred in 12 individual patients, and there was 100% agreement of data in the documentation of interventions in place (ventilation, arterial catheter, pulse oximetry, and vascular access) and in the presence of a witness at the onset of the arrest. All events were witnessed. Of the 15 events, video and monitor review revealed that 14 used waveform and numeric capnometry to confirm endotracheal tube/tracheostomy placement, but this section was only completed on the paper cardiopulmonary resuscitation record in three of the 14 cases. All records showed no discrepancies in the time of return of spontaneous circulation. The video and monitor review revealed delay in initiating cardiopulmonary resuscitation (mode, 2 min; two cases ≥ 7 min) and shockable rhythms (ventricular arrhythmia) in two cases. A sign of pulseless state was discovered in seven cases classified on the paper record as "always with a pulse." Those include sudden loss of consciousness, flat arterial line tracing, and abrupt drop in the partial pressure of exhaled carbon dioxide tracing (Eyewitness accounts of cardiopulmonary resuscitation are often inaccurate and incomplete. Review of information from video and electronically stored vital sign and waveform data provides more accurate information than review of paper-based cardiopulmonary resuscitation records and may provide the insight necessary to improving cardiopulmonary resuscitation.

  3. [Effects of a voice metronome on compression rate and depth in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 3-armed, randomized, simulation trial].

    Science.gov (United States)

    van Tulder, Raphael; Roth, Dominik; Krammel, Mario; Laggner, Roberta; Schriefl, Christoph; Kienbacher, Calvin; Lorenzo Hartmann, Alexander; Novosad, Heinz; Constantin Chwojka, Christof; Havel, Christoph; Schreiber, Wolfgang; Herkner, Harald

    2015-01-01

    We investigated the effect on compression rate and depth of a conventional metronome and a voice metronome in simulated telephone-assisted, protocol-driven bystander Cardiopulmonary resucitation (CPR) compared to standard instruction. Thirty-six lay volunteers performed 10 minutes of compression-only CPR in a prospective, investigator-blinded, 3-arm study on a manikin. Participants were randomized either to standard instruction ("push down firmly, 5 cm"), a regular metronome pacing 110 beats per minute (bpm), or a voice metronome continuously prompting "deep-deepdeep- deeper" at 110 bpm. The primary outcome was deviation from the ideal chest compression target range (50 mm compression depth x 100 compressions per minute x 10 minutes = 50 m). Secondary outcomes were CPR quality measures (compression and leaning depth, rate, no-flow times) and participants' related physiological response (heart rate, blood pressure and nine hole peg test and borg scales score). We used a linear regression model to calculate effects. The mean (SD) deviation from the ideal target range (50 m) was -11 (9) m in the standard group, -20 (11) m in the conventional metronome group (adjusted difference [95%, CI], 9.0 [1.2-17.5 m], P=.03), and -18 (9) m in the voice metronome group (adjusted difference, 7.2 [-0.9-15.3] m, P=.08). Secondary outcomes (CPR quality measures and physiological response of participants to CPR performance) showed no significant differences. Compared to standard instruction, the conventional metronome showed a significant negative effect on the chest compression target range. The voice metronome showed a non-significant negative effect and therefore cannot be recommended for regular use in telephone-assisted CPR.

  4. Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).

    Science.gov (United States)

    Axelsson, C; Karlsson, T; Axelsson, A B; Herlitz, J

    2009-10-01

    In animal and human studies, measuring the pressure of end tidal carbon dioxide (P(ET)CO2) has been shown to be a practical non-invasive method that correlates well with the pulmonary blood flow and cardiac output (CO) generated during cardiopulmonary resuscitation (CPR). This study aims to compare mechanical active compression-decompression (ACD) CPR with standard CPR according to P(ET)CO2 among patients with out-of-hospital cardiac arrest (OHCA), during CPR and with standardised ventilation. This prospective, on a cluster level, pseudo-randomised pilot trial took place in the Municipality of Göteborg. During a 2-year period, all patients aged >18 years suffering an out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology were enrolled. The present analysis included only tracheally intubated patients in whom P(ET)CO2 was measured for 15 min or until the detection of a pulse-giving rhythm. In all, 126 patients participated in the evaluation, 64 patients in the mechanical chest compression group and 62 patients in the control group. The group receiving mechanical ACD-CPR obtained the significantly highest P(ET)CO2 values according to the average (p=0.04), initial (p=0.01) and minimum (p=0.01) values. We found no significant difference according to the maximum value between groups. In this hypothesis generating study mechanical ACD-CPR compared with manual CPR generated the highest initial, minimum and average value of P(ET)CO2. Whether these data can be repeated and furthermore be associated with an improved outcome after OHCA need to be confirmed in a large prospective randomised trial.

  5. Simulated Trauma and Resuscitation Team Training course-evolution of a multidisciplinary trauma crisis resource management simulation course.

    Science.gov (United States)

    Gillman, Lawrence M; Brindley, Peter; Paton-Gay, John Damian; Engels, Paul T; Park, Jason; Vergis, Ashley; Widder, Sandy

    2016-07-01

    We previously reported on a pilot trauma multidisciplinary crisis resource course titled S.T.A.R.T.T. (Simulated Trauma and Resuscitative Team Training). Here, we study the course's evolution. Satisfaction was evaluated by postcourse survey. Trauma teams were evaluated using the Ottawa global rating scale and an Advanced Trauma Life Support primary survey checklist. Eleven "trauma teams," consisting of physicians, nurses, and respiratory therapists, each completed 4 crisis simulations over 3 courses. Satisfaction remained high among participants with overall mean satisfaction being 4.39 on a 5-point Likert scale. As participants progressed through scenarios, improvements in global rating scale scores were seen between the 1st and 4th (29.8 vs 36.1 of 42, P = .022), 2nd and 3rd (28.2 vs 34.6, P = .017), and 2nd and 4th (28.2 vs 36.1, P = .003) scenarios. There were no differences in Advanced Trauma Life Support checklist with mean scores for each scenario ranging 11.3 to 13.2 of 17. The evolved Simulated Trauma and Resuscitative Team Training curriculum has maintained high participant satisfaction and is associated with improvement in team crisis resource management skills over the duration of the course. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Are radiologists able to manage serious anaphylactic reactions and cardiopulmonary arrest?

    Science.gov (United States)

    Tapping, C R; Culverwell, A D

    2009-10-01

    In this study, we aimed to assess the ability and confidence of radiologists in managing adult life support in cardiopulmonary arrest and acute anaphylaxis reactions. We used a questionnaire survey assessing the knowledge of how to manage and the confidence in managing an adult cardiorespiratory arrest scenario. This was sent to 165 radiology consultants and registrars in 6 NHS trusts in Yorkshire: 105 participated. The questionnaire elicited basic demographic details and included eight questions aimed at assessing recent training, knowledge and confidence in the management of adult resuscitation (Resuscitation Council (UK) 2005 guidelines) and acute anaphylaxis. Despite the fact that 90% of participants stated that they would feel confident to initiate life support, the average score from the questions assessing life support procedure was 2.3 out of 5, with only 13% of participants answering all questions correctly. There was no correlation between grade of radiologist and likelihood of a correct answer, nor was there a correlation between feeling confident and knowing the correct life support procedure. Flaws in training were highlighted, with only 61% of radiologists having attended a life support course in the last 4 years. Those who had attended a course more recently were more likely to perform cardiopulmonary resuscitation correctly (p = 0.02). Individuals who were confident in initialising cardiopulmonary resuscitation were more likely to be confident that other members of staff could assist them (p = 0.028). This study emphasises the need for regular life support training and the need to alter the attitude of radiologists, who must consider it their role to initiate effective life support in the radiology environment.

  7. Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.

    Science.gov (United States)

    Allan, Catherine K; Thiagarajan, Ravi R; Beke, Dorothy; Imprescia, Annette; Kappus, Liana J; Garden, Alexander; Hayes, Gavin; Laussen, Peter C; Bacha, Emile; Weinstock, Peter H

    2010-09-01

    Resuscitation of pediatric cardiac patients involves unique and complex physiology, requiring multidisciplinary collaboration and teamwork. To optimize team performance, we created a multidisciplinary Crisis Resource Management training course that addressed both teamwork and technical skill needs for the pediatric cardiac intensive care unit. We sought to determine whether participation improved caregiver comfort and confidence levels regarding future resuscitation events. We developed a simulation-based, in situ Crisis Resource Management curriculum using pediatric cardiac intensive care unit scenarios and unit-specific resuscitation equipment, including an extracorporeal membrane oxygenation circuit. Participants replicated the composition of a clinical team. Extensive video-based debriefing followed each scenario, focusing on teamwork principles and technical resuscitation skills. Pre- and postparticipation questionnaires were used to determine the effects on participants' comfort and confidence regarding participation in future resuscitations. A total of 182 providers (127 nurses, 50 physicians, 2 respiratory therapists, 3 nurse practitioners) participated in the course. All participants scored the usefulness of the program and scenarios as 4 of 5 or higher (5 = most useful). There was significant improvement in participants' perceived ability to function as a code team member and confidence in a code (P skills and improve team function. Participants found the experience useful and reported improved ability to function in a code. Further work is needed to determine whether participation in the Crisis Resource Management program objectively improves team function during real resuscitations. 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  8. Teamwork during resuscitation.

    Science.gov (United States)

    Weinstock, Peter; Halamek, Louis P

    2008-08-01

    Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

  9. Medical students’ experiences of resuscitation and discussions surrounding resuscitation status

    Directory of Open Access Journals (Sweden)

    Aggarwal AR

    2018-01-01

    Full Text Available Asha R Aggarwal, Iqbal Khan Department of Medical Education, Northampton General Hospital, Northampton, UK Objectives: In the UK, cardiopulmonary resuscitation (CPR should be undertaken in the event of cardiac arrest unless a patient has a “Do Not Attempt CPR” document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future. Methods: Twenty final-year medical students from two medical schools were interviewed about their experiences on the wards. Interviews were transcribed verbatim, and thematic analysis was undertaken.Results: Students who had witnessed CPR on the wards found that aspects of it were distressing. A significant minority had never seen resuscitation status being discussed with a patient. No students reported seeing a difficult conversation. Half of the students interviewed reported being turned away from difficult conversations by clinicians. Only two of the twenty students would feel comfortable raising the issue of resuscitation with a patient. Conclusion: It is vital that doctors are comfortable talking to patients about resuscitation. Given the increasing importance of this aspect of communication, it should be considered for inclusion in the formal communication skills teaching during medical school. Keywords: undergraduate, communication, DNACPR, palliative care, end of life care

  10. Parent Advocacy Group for Events of Resuscitation.

    Science.gov (United States)

    Pasek, Tracy Ann; Licata, Jodi

    2016-06-01

    The presence of patients' families during resuscitation has been an important practice issue. An American Association of Critical-Care Nurses (AACN) practice alert "Family Presence During Resuscitation and Invasive Procedures" supports family members of patients undergoing resuscitation being given the option of bedside presence. Parent Advocacy Group for Events of Resuscitation (PAGER) is an interdisciplinary collaborative in the pediatric intensive care unit. To ensure that patients' families are provided the option of being with their child during cardiopulmonary resuscitation. Resuscitation data were collected for 12 months by using the AACN practice alert audit tool. The Family Nurse Caring Belief Scale was administered to 150 pediatric intensive care unit nurses. PAGER nurses received crisis education. Pediatric intensive care unit nurses were supportive of providing the option of family presence during resuscitation. Family Nurse Caring Belief Scale data revealed areas for improvement in family caring practices. PAGER was implemented with positive outcomes for 2 families. PAGER has improved the care of families whose children experience cardiopulmonary resuscitation and should be implemented in pediatric critical care units. PAGER nurses are prepared to serve as role models in providing family-sensitive care during crisis. ©2016 American Association of Critical-Care Nurses.

  11. [German resuscitation registry : science and resuscitation research].

    Science.gov (United States)

    Gräsner, J-T; Seewald, S; Bohn, A; Fischer, M; Messelken, M; Jantzen, T; Wnent, J

    2014-06-01

    Sudden death due to cardiac arrest represents one of the greatest challenges facing modern medicine, not only because of the massive number of cases involved but also because of its tremendous social and economic impact. For many years, the magic figure of 1 per 1000 inhabitants per year was generally accepted as an estimate of the annual incidence of sudden death in the industrialized world, with a survival rate of 6 %. This estimate was based on large numbers of published reports of local, regional, national and multinational experience in the management of cardiac arrest. Measuring the global incidence of cardiac arrest is challenging as many different definitions of patient populations are used. Randomized controlled trials (RCT) provide insights into the value of specific treatments or treatment strategies in a well-defined section of a population. Registries do not compete with clinical studies, but represent a useful supplement to them. Surveys and registries provide insights into the ways in which scientific findings and guidelines are being implemented in clinical practice. However, as with clinical studies, comprehensive preparations are needed in order to establish a registry. This is all the more decisive because not all of the questions that may arise are known at the time when the registry is established. The German resuscitation registry started in May 2007 and currently more than 230 paramedic services and hospitals take part. More than 45,000 cases of out-of-hospital cardiac arrest and in-hospital cardiac arrest are included. With this background the German resuscitation registry is one of the largest databases in emergency medicine in Germany. After 5 years of running the preclinical care dataset was revised in 2012. Data variables that reflect current or new treatment were added to the registry. The postresuscitation basic care and telephone cardiopulmonary resuscitation (CPR) datasets were developed in 2012 and 2013 as well. The German

  12. Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal.

    Science.gov (United States)

    Kc, Ashish; Wrammert, Johan; Nelin, Viktoria; Clark, Robert B; Ewald, Uwe; Peterson, Stefan; Målqvist, Mats

    2017-04-11

    Each year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal. A time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis. One hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill

  13. Cardiac Arrest During Medically-Supervised Exercise Training: A Report of Fifteen Successful Defibrillations.

    Science.gov (United States)

    Pyfer, Howard R.; And Others

    The Cardio-Pulmonary Research Institute conducted an exercise program for men with a history of coronary heart disease. Over 7 years, there were 15 cases of cardiac arrest during exercise (one for every 6,000 man-hours of exercise). Trained medical personnel were present in all cases, and all were resuscitated by electrical defibrillation with no…

  14. Checklist usage decreases critical task omissions when training residents to separate from simulated cardiopulmonary bypass.

    Science.gov (United States)

    Petrik, Edward W; Ho, Dennis; Elahi, Maqsood; Ball, Timothy R; Hofkamp, Michael P; Wehbe-Janek, Hania; Culp, William C; Villamaria, Frank J

    2014-12-01

    Separation from cardiopulmonary bypass (CPB) requires multiple preparatory steps, during which mistakes, omissions, and human errors may occur. Checklists have been used extensively in aviation to improve performance of complex, multistep tasks. The aim of this study was to (1) develop a checklist using a modified Delphi process to identify essential steps necessary to prepare for separation from CPB, and (2) compare the frequency of completed items with and without the use of a checklist in simulation. It was hypothesized that the use of a checklist would reduce the number of omissions. High-fidelity simulation study. University-affiliated tertiary care facility. Seven cardiac anesthesiologists created a checklist using a modified Delphi process. Ten residents participated in 4 scenarios separating from CPB in simulation. Each scenario was performed first without a checklist and then again with a checklist. An observer graded participants' performance. A pre-separation checklist containing 9 tasks was created using the Delphi process. Without using this checklist, 4 tasks were completed in at least 75% of scenarios, and 8 tasks were completed at least 75% of the time when using the checklist. There was a significant improvement in completion of 5 of the 9 items (pchecklist of steps in preparing to separate from CPB. Using this checklist during simulation resulted in increased frequency of completing designated tasks in comparison to relying on memory alone. Checklists may reduce omission errors during complex periods of anesthesiologists' perioperative workflow. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. An evaluation of the effectiveness of the Opportunities for Resuscitation and Citizen Safety (ORCS) defibrillator training programme designed for older school children.

    Science.gov (United States)

    Younas, Shamyla; Raynes, Alison; Morton, Sally; Mackway-Jones, Kevin

    2006-11-01

    The aim of our study was to evaluate the effect of an automated external defibrillation (AED) training programme on the knowledge, attitudes and application of BLS and AED use in young people of secondary school age in Manchester, United Kingdom. Students from two schools who had piloted Opportunities for Resuscitation and Citizen Safety (ORCS) in the academic year 2004/2005 volunteered to partake in the study. This 'ORCS intervention' group was compared against a control group, which consisted of students who had no formal training in resuscitation nor, to our knowledge, any other form of life support training during their time at secondary school. All students were assessed and scored on their knowledge and performance of the BLS algorithm (in accordance with the UK Resuscitation Council ('Resuscitation Guidelines for the Citizen') and the use of a trainer defibrillator on a fictional cardiac arrest scenario. We compared 34 ORCS-trained students with 25 control students, all aged between 13 and 16 years. Approximately, twice as many ORCS-trained students than the control students performed many parts of the algorithm correctly, such as checking for danger, checking for response, opening the airway and checking for breathing. More than three times as many ORCS-trained students than controls correctly performed CPR (50% versus 12% of students). As expected, the use of the AED was the part of the algorithm performed worst, but was performed correctly by six times as many ORCS students as controls (27% versus 4% of students). This study demonstrates that training through the ORCS scheme has a positive influence on the ability of secondary school teenagers to perform emergency life support (ELS), but particularly in their ability to deploy an AED and perform CPR.

  16. Noninvasive positive pressure ventilation enhances the effects of aerobic training on cardiopulmonary function.

    Directory of Open Access Journals (Sweden)

    Takashi Moriki

    Full Text Available The purpose of this study was to determine the effect of aerobic training under noninvasive positive pressure ventilation (NPPV on maximal oxygen uptake ([Formula: see text].Ten healthy young male volunteers participated in the study. Before the training, stroke volume (SV and cardiac output (CO were measured in all subjects under 0, 4, 8, and 12 cmH2O NPPV at rest. Then, the subjects exercised on a cycle ergometer at 60% of pre-training [Formula: see text] for 30 min daily for 5 consecutive days with/without NPPV. The 5-day exercise protocol was repeated after a three-week washout period without/with NPPV. The primary endpoint was changes in [Formula: see text]. The secondary endpoints were changes in SV, CO, maximum heart rate (HRmax, maximum respiratory rate (RRmax, maximum expiratory minute volume (VEmax and the percent change in plasma volume (PV.NPPV at 12 cmH2O significantly reduced SV and CO at rest. [Formula: see text] significantly increased after 5 days training with and without NPPV, but the magnitude of increase in [Formula: see text] after training under 12 cmH2O NPPV was significantly higher than after training without NPPV. VEmax significantly increased after training under NPPV, but not after training without NPPV. HRmax and RRmax did not change during training irrespective of NPPV. The percent change in PV was similar between training with and without NPPV. The 5-day training program with NPPV resulted in greater improvement in [Formula: see text] than without NPPV.Aerobic training under NPPV has add-on effects on [Formula: see text] and exercise-related health benefits in healthy young men.

  17. [Characteristics and evolution of cardiopulmonary arrest in children in Spain: comparison between autonomous communities].

    Science.gov (United States)

    López-Herce Cid, J; García Sanz, C; Domínguez Sampedro, P; Carrillo Alvarez, A; Rodríguez Núñez, A; Calvo Macías, C

    2006-01-01

    In Spain there are many differences between autonomous regions in terms of geography, population distribution and health care organisation. We do not know if these differences could have influenced the characteristics and evolution of cardiopulmonary arrest in children. A secondary analysis of data from a prospective, multicenter and previously published study, analysing cardiorespiratory arrest in children was made to compare the characteristics and evolution of cardiopulmonary arrest in children depending on the region where the arrest occurred. We studied 283 children aged between 7 days and 17 years who suffered respiratory or cardiopulmonary arrest. Data were recorded according to the international Utstein style recommendations. Patients were classified according to the autonomous region where the cardiac arrest occurred: Catalonia (94 cases), Andalusia (64 cases), Madrid (61 cases) and the rest of the regions (64 patients). A statistical analysis was performed to compare the characteristics of cardiac arrest, resuscitation, evolution and survival between the four groups. Sixty percent of patients initially survived the cardiac arrest episode and 33% (94 patients) were still alive one year later. No significant differences in the characteristics of arrest, resuscitation and evolution were found when the autonomous regions were compared. Even though the differences were not statistically significant, there was a tendency to less than expected survival in Andalusia and higher than expected survival in Catalonia. There are no important differences in the characteristics of pediatric cardiopulmonary arrest, resuscitation, evolution and survival between the autonomous regions in Spain. Additional studies are needed to analyze the hypothetical influence of health care organization and life support training on survival.

  18. Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

    DEFF Research Database (Denmark)

    Saltbaek, Lena; Michelsen, Hanne M; Nelausen, Knud M

    2013-01-01

    The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated.......The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated....

  19. Gastric rupture following cardiopulmonary resuscitation: case report

    OpenAIRE

    Dias, Lucas Teixeira; Mendes, Lucas Cronemberger Maia; Mello, Patrícia Machado Veiga de Carvalho; Santos, Lina Gomes; Vasconcelos, Jayro Tadeu Paiva de

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: A ruptura gástrica é uma rara complicação das manobras de reanimação cardiopulmonar (RCP), com incidência de 0,1% dos casos. O desconhecimento dessa possível complicação durante essas manobras impede sua identificação e reduz a probabilidade de sobrevivência do paciente. O objetivo deste trabalho foi abordar um caso de abdômen agudo por ruptura gástrica após manobra de RCP, prontamente diagnosticada e tratada. RELATO DO CASO: Paciente do sexo feminino, de 76 anos, i...

  20. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was begun...... immediately by artificial ventilation and simultaneous external chest compressions. Epinephrine was administered after 8 min of CPR. One group (n = 5) of animals received no buffer treatment while another (n = 5) received an infusion of 75 mmol sodium bicarbonate and a third group (n = 5) received......, bicarbonate and tris-buffer mixture both quickly passed through the blood-brain barrier. When buffer treatment is indicated during CPR, a buffer which does not increase tissue PCO2 may be the drug of choice....

  1. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was begun......; improved cardiac output during CPR resulted in more efficient tissue CO2 elimination and was associated with increased survival rates. PaCO2 was also somewhat reduced by efficient alveolar hyperventilation. The arterial PCO2 and pH did not reflect the acid-base balance in peripheral tissues. During CPR...... immediately by artificial ventilation and simultaneous external chest compressions. Epinephrine was administered after 8 min of CPR. One group (n = 5) of animals received no buffer treatment while another (n = 5) received an infusion of 75 mmol sodium bicarbonate and a third group (n = 5) received...

  2. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S

    1986-01-01

    immediately by artificial ventilation and simultaneous external chest compressions. Epinephrine was administered after 8 min of CPR. One group (n = 5) of animals received no buffer treatment while another (n = 5) received an infusion of 75 mmol sodium bicarbonate and a third group (n = 5) received......, bicarbonate and tris-buffer mixture both quickly passed through the blood-brain barrier. When buffer treatment is indicated during CPR, a buffer which does not increase tissue PCO2 may be the drug of choice....

  3. Knowledge and Practice of Cardiopulmonary Resuscitation ...

    African Journals Online (AJOL)

    In this study, the knowledge and practice of the 2000 CPR guidelines of doctors and nurses in Benin City, Nigeria was evaluated. This cross sectional study was conducted in six health facilities in Benin City. A structured self administered questionnaire was used to test the knowledge and practice of CPR of 145 doctors and ...

  4. Training laypersons and hospital personnel in basic resuscitation techniques: an approach to impact the global trauma burden in Mozambique.

    Science.gov (United States)

    Merchant, Amina; Outhay, Malena; Gonzaléz-Calvo, Lazáro; Moon, Troy D; Sidat, Mohsin; Taibo, Catia Luciana Abdulfattáhe; McQueen, Kelly

    2015-06-01

    Over half of prehospital deaths in low-income countries are the result of airway compromise, respiratory failure, or uncontrolled hemorrhage; all three conditions can be addressed using simple first-aid measures. For both hospital personnel and laypersons, a basic trauma resuscitation training in modified ABCD (airway, breathing, circulation, disability) techniques can be easily learned and applied to increase the number of first responders in Mozambique, a resource-challenged country. A trauma training session was administered to 100 people in Mozambique: half were hospital personnel from 7 district medical centers and the other half were selected laypersons. This session included a pre-test, intervention, and post-test to evaluate and demonstrate first response skills. Eighty-eight people completed both the pre- and post-tests. Following the education intervention, both groups demonstrated an improvement in test scores. Hospital personnel had a mean post-test score of 60% (SD = 17, N = 43) and community laypeople had a mean score of 51% (SD = 16, N = 45). A t test for equal variances demonstrated significant difference between the post-intervention scores for the two groups (p = 0.01). All 100 participants were able to open an airway, externally control hemorrhage, and transport a patient with appropriate precautions. The trauma training session served as new information that improved knowledge as well as skills for both groups, and increased the number of capable responders in Mozambique. This study supports WHO recommendations to utilize the strengths of a developing nation-population-as the first step in establishing an organized trauma triage system.

  5. Nationwide survey of resuscitation education in Finland.

    Science.gov (United States)

    Jäntti, H; Silfvast, T; Turpeinen, A; Paakkonen, H; Uusaro, A

    2009-09-01

    Good-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels. The following institutes were included in an anonymous survey: medical schools (teaching future physicians), universities of applied sciences (paramedics), colleges (emergency medical technicians) and emergency services college (fire-fighters). Hours of teaching theory lessons of CPR and hours of small group training were evaluated. In particular, we focussed on the teaching methods for adequate chest compression rate and depth. Twenty-one of 30 institutes responded to the questionnaire. The median for hours of theory lessons of CPR was 8h (range: 2-28 h). The median for hours of small group training was 10 (range: 3-40 h). The methods of teaching adequate chest compression rate were instructors' visual estimation in 28.5% of the institutions, watch in 33.3%, metronome in 9.5% and manikins' graphic in 28.5% of institutions. The methods of teaching adequate chest compression depth were instructors' visual estimation in 33.3%, in manikins light indicators in 23.8% and manikins' graphics in 52.3% of institutions. The hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructor's visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.

  6. A systematic review of effects of concurrent strength and endurance training on the health-related quality of life and cardiopulmonary status in patients with HIV/AIDS.

    Science.gov (United States)

    Gomes Neto, Mansueto; Ogalha, Cecília; Andrade, Antônio Marcos; Brites, Carlos

    2013-01-01

    To determine the effects of concurrent strength and endurance training (concurrent training) on the Health-Related Quality of Life (HRQOL) and cardiopulmonary status among HIV-infected patients, using a systematic search strategy of randomized, controlled trials (RCTs). A systematic review was performed by two independent reviewers using Cochrane Collaboration protocol. The sources used in this review were Cochrane Library, EMBASE, LILACS, MEDLINE, PEDro and Web of Science from 1950 to August 2012. The PEDro score was used to evaluate methodological quality. Individual studies suggested that concurrent training contributed to improved HRQOL and cardiovascular status. Concurrent training appears to be safe and may be beneficial for medically stable adults living with HIV. The rates of nonadherence were of 16%. Concurrent training improves the HRQOL and cardiopulmonary status. It may be an important intervention in the care and treatment of adults living with HIV. Further research is needed to determine the minimal and optimal duration, frequency, and intensity of exercise needed to produce beneficial changes in the HIV-infected population subgroups.

  7. [Chest compression without ventilation during basic life support? Confirmation of the validity of the European Resuscitation Council (ERC) guidelines 2005].

    Science.gov (United States)

    Kreimeier, U; Dirks, B; Arntz, R; Bahr, J; Goldschmidt, P; Roessler, M; Sasse, M; Toursarkissian, M

    2008-08-01

    Basic life support (BLS) refers to maintaining airway patency and supporting breathing and the circulation, without the use of equipment other than infection protection measures. The scientific advisory committee of the American Heart Association (AHA) published recommendations (online-first) on March 31 2008, which promote a call to action for bystanders who are not or not sufficiently trained in cardiopulmonary resuscitation (CPR) and witness an adult out-of-hospital sudden collapse probably of cardiac origin. These bystanders should provide chest compression without ventilation (so-called compression-only CPR). If bystanders were previously trained and thus confident with CPR, they should decide between conventional CPR (chest compression plus ventilation at a ratio of 30:2) and chest compression alone. However, considering current evidence-based medicine and latest scientific data both the European Resuscitation Council (ERC) and the German Resuscitation Council (GRC) do not at present intend to change or supplement the current resuscitation guidelines "Basic life support for adults". Both organisations do not see any need for change or amendments in central European practice and continue to recommend that only those lay rescuers that are not willing or unable to give mouth-to-mouth ventilation should provide CPR solely by uninterrupted chest compressions until professional help arrives. It is also stressed that the training of young people especially teenagers as lay rescuers should be promoted and the establishment of training programs through emergency medical organizations and in schools should be encouraged.

  8. Does teaching crisis resource management skills improve resuscitation performance in pediatric residents?*.

    Science.gov (United States)

    Blackwood, Jaime; Duff, Jonathan P; Nettel-Aguirre, Alberto; Djogovic, Dennis; Joynt, Chloe

    2014-05-01

    The effect of teaching crisis resource management skills on the resuscitation performance of pediatric residents is unknown. The primary objective of this pilot study was to determine if teaching crisis resource management to residents leads to improved clinical and crisis resource management performance in simulated pediatric resuscitation scenarios. A prospective, randomized control pilot study. Simulation facility at tertiary pediatric hospital. Junior pediatric residents. Junior pediatric residents were randomized to 1 hour of crisis resource management instruction or no additional training. Time to predetermined resuscitation tasks was noted in simulated resuscitation scenarios immediately after intervention and again 3 months post intervention. Crisis resource management skills were evaluated using the Ottawa Global Rating Scale. Fifteen junior residents participated in the study, of which seven in the intervention group. The intervention crisis resource management group placed monitor leads 24.6 seconds earlier (p = 0.02), placed an IV 47.1 seconds sooner (p = 0.04), called for help 50.4 seconds faster (p = 0.03), and checked for a pulse after noticing a rhythm change 84.9 seconds quicker (p = 0.01). There was no statistically significant difference in time to initiation of cardiopulmonary resuscitation (p = 0.264). The intervention group had overall crisis resource management performance scores 1.15 points higher (Ottawa Global Rating Scale [out of 7]) (p = 0.02). Three months later, these differences between the groups persisted. A 1-hour crisis resource management teaching session improved time to critical initial steps of pediatric resuscitation and crisis resource management performance as measured by the Ottawa Global Rating Scale. The control group did not develop these crisis resource management skills over 3 months of standard training indicating that obtaining these skills requires specific education. Larger studies of crisis resource education are

  9. Non-resuscitative first-aid training for children and laypeople: a systematic review.

    Science.gov (United States)

    He, Zhimin; Wynn, Persephone; Kendrick, Denise

    2014-09-01

    Relatively little is currently known about the effectiveness of first-aid training for children and laypeople. We have undertaken a systematic review to synthesise the evidence and inform policy and practice in this area. A range of bibliographic databases were searched. Studies were eligible if they used experimental designs, provided first-aid training to laypeople or children and reported first-aid knowledge, skills behaviours or confidence. Studies were selected for inclusion, data extracted and risk of bias assessed by two independent reviewers. Findings were synthesised narratively. 23 studies (14 randomised controlled trials and 9 non-randomised studies) were included, 12 of which recruited children or young people (≤19 years old). Most studies reported significant effects favouring the intervention group; 11 out of 16 studies reported significant increases in first-aid knowledge; 11 out of 13 studies reported significant increases in first-aid skills; 2 out of 5 studies reported significant improvements in helping behaviour; and 2 out of 3 studies reported significant increases in confidence in undertaking first aid. Only one study undertook an economic evaluation; finding an intensive instructor-led course was more effective, but had significantly higher costs than either a less-intensive instructor-led course or a video-delivered course. Most studies were at risk of bias, particularly selection, performance or detection bias. There is some evidence to support provision of first-aid training, particularly for children or young people, but many studies were judged to be at risk of bias. Conclusions cannot be drawn about which first-aid training courses or programmes are most effective or the age at which training can be most effectively provided. Few studies evaluated training in adult laypeople. High-quality studies are required assessing effectiveness and cost-effectiveness of standardised first-aid training to inform policy development and provision