Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study

Background

The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings.

Methods

We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders' sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes.

Results

The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76-1.61), 30-day survival (aOR 1.23, 95% CI: 0.83-1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34-1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest.

Conclusion

There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.

Empowering the next Generation: An innovative "Kids Save Lives" blended learning programme for schoolchildren training

INTRODUCTION

Guidelines recommend teaching resuscitation from school age; however, little is known about the best methods to provide it. We devised a blended learning program for primary and secondary students (Kids Save Lives - KSL) consisting of brief lectures, practical training with mannequins, and virtual reality. We aimed to evaluate its impact on students' attitudes towards intervening during cardiac arrest and their knowledge about basic life support.

METHODS

This observational, prospective, before-and-after study assessed attitudes and basic life support knowledge in primary and secondary school children exposed to the KSL program. 20 events were conducted in the metropolitan area of Bologna, Italy. A multiple-choice test (before and after the course) explored attitude, knowledge and perceptions of realism, engagement, and agreement with the virtual reality method.

RESULTS

A total of 1,179 students (response rate 81.4%) were included in the final analysis, with 12.89% from primary schools, 5.94% from middle schools, and 81.17% from high schools. Students' willingness to intervene during a cardiac arrest rose from 56.9% to 93.1% (p < 0.001) post-course. The course's realism, engagement, and future prospects received positive feedback, with median scores notably higher in primary schools compared to secondary schools.

CONCLUSION

The blended learning method improved students' understanding of basic life support techniques and their attitude to act during cardiac arrest situations. The positive reception of the virtual reality component underscores technology's potential to bolster engagement and should be further explored for basic life support teaching in schoolchildren.

Exploring cardiac arrest in 'at-home' settings: Concepts derived from a qualitative interview study with layperson bystanders

BACKGROUND

Two thirds of Out-of-Hospital Cardiac Arrests (OHCAs) occur at the patient's home ('at-home-CA'), where bystander CPR (B-CPR) rates are significantly lower than in public locations. Knowledge about the circumstances of this specific setting has mainly been limited to quantitative data. To develop a more conceptual understanding of the circumstances and dynamics of 'at-home CA', we conducted a qualitative interview study.

METHODS

Twenty-one semi-structured in-depth interviews were performed with laypersons who had witnessed 'at-home CA'. The interviews were audio recorded, transcribed, and analysed by qualitative content analysis (QCA). A category system was developed to classify facilitating and impeding factors and to finally derive overarching concepts of 'at-home CA'.

RESULTS

Qualitative Content Analysis yielded 1'347 relevant interview segments. Of these, 398 related to factors facilitating B-CPR, 328 to factors impeding, and 621 were classified neutral. Some of these factors were specific to 'at-home CA'. The privacy context was found to be a particularly supportive factor, as it enhanced the commitment to act and facilitated the detection of symptoms. Impeding factors, aggravated in 'at-home CA' settings, included limited support from other bystanders, acute stress response and impaired situational judgement, as well as physical challenges when positioning the patient. We derived six overarching concepts defining the 'at-home CA' situation: (a) unexpectedness of the event, (b) acute stress response, (c) situational judgement, (d) awareness of the necessity to perform B-CPR, (e) initial position of the patient, (f) automaticity of actions.

CONCLUSION

Integrating these concepts into dispatch protocols and layperson training may improve dispatcher-bystander interaction and the outcomes of 'at-home CA'.

Comparison of instructor-led compression-only cardiopulmonary resuscitation and automated external defibrillator training for secondary school students: A multicenter noninferiority randomized trial

Background

Many barriers exist to the wider and sustainable implementation of basic life support (BLS) training in secondary schools. Whether trained teacher instructors are not worse than healthcare instructors by 20% (noninferiority margin) of simulated BLS skills for secondary school students is unclear.

Methods

We conducted a two-armed, parallel, noninferiority, blinded, randomized controlled trial at four secondary schools in Hong Kong after teachers had undergone BLS training. Students were randomized to either the trained teacher or healthcare instructor group for the 2-hour compression-only cardiopulmonary resuscitation and automated external defibrillator (CO-CPRAED) course. The assessors for the students' BLS skill performance six months after the CO-CPRAED course were blinded.

Results

Of the 33 trained teachers, 13 (39.4%) volunteered to be instructors for the CO-CPRAED course. Three hundred and eleven students (median age: 15 years, 67% males) were randomized to either the teacher (n = 161) or healthcare (n = 150) instructor group. The BLS skill performance passing rate (%) at six months was high in both instructor groups (teacher: 88% versus healthcare: 91%; mean difference: -3%, 95% CI: -11% to 5%; P = 0.22). The students' knowledge levels remained high (>90%) and were similar between instructor groups at six months (P = 0.91). The teachers' willingness to teach BLS to students was mildly positive. However, the students were extremely positive towards learning and performing BLS.

Conclusions

A brief 2-hour CO-CPRAED intervention by trained teachers was noninferior to healthcare instructors and it was associated with students' very positive attitudes towards CPR, and retention of knowledge and BLS skills.

The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action

Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.

The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

BACKGROUND

Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies.

METHODS

This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI).

RESULTS

Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group.

CONCLUSION

Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.