Education in cardiopulmonary resuscitation in Sweden and its clinical consequences

Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards

BACKGROUND

Adherence to cardiopulmonary resuscitation (CPR) guidelines in treatment of in-hospital cardiac arrest (IHCA) have been associated with favourable patient outcome. The aim of this study was to evaluate if compliance with initial CPR guidelines and patient outcome of witnessed IHCA events were associated with the place of arrest defined as monitored versus non-monitored ward.

METHODS

A total of 956 witnessed IHCA events in adult patients at six hospitals during 2018 to 2019, were extracted from the Swedish Registry of Cardiopulmonary Resuscitation. Initial CPR guidelines were: ≤1 min from collapse to alert of the rapid response team, ≤1 min from collapse to start of CPR, ≤3 min from collapse to defibrillation of shockable rhythm.

RESULTS

The odds of compliance with guidelines was higher on monitored wards vs non-monitored wards, even after adjustment for factors that could affect staffing and resources. The place of arrest was not a significant factor for sustained return of spontaneous circulation, survival at 30 days, or neurological status at discharge, when adjusting for clinically relevant confounders. Compliance with initial CPR guidelines remained a significant factor for survival to 30 days and favourable neurological outcome at discharge regardless of other confounders.

CONCLUSION

Compliance with initial CPR guidelines was higher in witnessed IHCA events on monitored wards than on non-monitored wards, which indicates that healthcare professionals in monitored wards are quicker to recognize a cardiac arrest and initiate treatment. When initial CPR guidelines are followed, the place of arrest does not influence patient outcome.

Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study

OBJECTIVES

We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival.

SETTING

This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods.

RESULTS

We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006).

CONCLUSION

Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

Faculty Development Approaches for Life Support Courses: A Scoping Review

The aim of this scoping review initiated by the Education, Implementation and Teams Task Force of the International Liaison Committee on Resuscitation was to identify faculty development approaches to improve instructional competence in accredited life support courses. We searched PubMed, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials to identify studies published from January 1, 1966 to December 31, 2021 on approaches to improve faculty development for life support courses. Data on participant characteristics, interventions, design, and outcomes of included studies were extracted. Of the initially identified 10 310 studies, we included 20 studies (5 conference abstracts, 1 short communication, 14 full-length articles). Among them, 12 studies aimed to improve instructors/candidates' teaching ability in basic life support courses. A wide variety of interventions were identified. The interventions were categorized into 4 themes: instructor qualification/training (n=9), assessment tools (n=3), teaching skills enhancement (n=3), and additional courses for instructors (n=5). Most studies showed that these interventions improved specific teaching ability or confidence of the instructors and learning outcomes in different kinds of life support courses. However, no studies addressed clinical outcomes of patients. In conclusion, the faculty development approaches for instructors are generally associated with improved learning outcomes for participants, and also improved teaching ability and self-confidence of the instructors. It is encouraged that local organizations implement faculty development programs for their teaching staff of their accredited resuscitation courses. Further studies should explore the best ways to strengthen and maintain instructor competency, and define the cost-effectiveness of various different faculty development strategies.

Out of hospital cardiac arrest: experience of a bystander CPR training program in Karachi, Pakistan

Background

Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.

Methods

Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR.

Results

The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27).

Conclusion

Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA.

Public knowledge and attitudes toward automated external defibrillators use among first aid eLearning course participants: a survey

Objective

Survival from out-of-hospital cardiac arrest (OHCA) often depends on the effective and immediate use of automated external defibrillators (AEDs). Given that there have been few studies about AED use in China, the purpose of this study is to investigate the knowledge and attitudes regarding AED use among the Chinese public, then provide an effective suggestion for AED education strategies and legislation.

Method

The online survey was conducted among Chinese participants of the First Aid eLearning courses in June 2020.

Result

A total of 2565 (95.00%) surveys were completed, only 23.46% of respondents with non-medical related respondents reported having attended previous AED training courses. Regarding the basic knowledge of AEDs, few respondents (12.28%, n = 315) could answer all four questions correctly. 95.67% (n = 2454) were willing to learn AED use. Even if without the precondition of being skilled in AEDs, the female was more likely to rescue OHCA patients than the male (p = 0.003). Almost all respondents (96.65%) showed a strong willingness to rescue OHCA patients with training in using AEDs. The top four barriers to rescuing OHCA patients were lack of practical performing ability (60.47%), fear of hurting patients (59.30%), inadequate knowledge of resuscitation techniques (44.19%), and worry about taking legal responsibility (26.74%).

Conclusion

Our study reflects a deficiency of AED knowledge among the general public in China. However, positive attitudes towards rescuing OHCA patients and learning AED use were observed, which indicates that measures need to be taken to disseminate knowledge and use of AEDs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-022-01863-1.

Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

OBJECTIVE

The purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.

DESIGN

Cross-sectional study.

METHODS

Adult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.

RESULTS

Overall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).

CONCLUSION

Survival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

Factors influencing the willingness to perform bystander cardiopulmonary resuscitation on the workplace: a study from North-Eastern Italy

Background:

Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR.

Methods:

Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated.

Results:

A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p=0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p=0.002), and exhibiting a better knowledge of CPR (KS≥75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442-14.350).

Conclusions:

Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.(www.actabiomedica.it)

Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden

Supplemental Digital Content is available in the text.

Objective

Theoretical knowledge and ability to perform cardiopulmonary resuscitation (CPR) are unknown with regard to provided training. The aim of this study was to evaluate in-hospital healthcare professionals’ (HCPs) theoretical knowledge of CPR and their self-assessed ability to perform CPR and also to assess possible affecting factors.

Method

A questionnaire was sent to n = 5323 HCPs containing a nine-question knowledge test and a Likert scale measuring self-assessed ability. A factor score of self-assessed ability and a ratio scale of correct answers were dependent variables in multiple linear regression.

Results

Only 41% of the responding HCPs passed the knowledge test with seven or more correct answers. Nurses had the highest pass rate (50%) and the highest attendance rate at CPR training (56%). The ability to perform defibrillation was strongly agreed by 43% and the ability of leadership by only 7%. Working on a monitored ward, CPR training 0–6 months ago and being a nurse or physician were factors associated with more correct answers and higher ratings of abilities.

Conclusion

The overall theoretical knowledge was poor and ratings of self-assessed abilities to perform CPR were low. Working on a monitored ward, recently attended CPR training and being a nurse or physician were factors associated with higher theoretical knowledge and higher ratings of self-assessed ability to perform CPR. These findings imply prioritisation of CPR training.

Lay People Training in CPR and in the Use of an Automated External Defibrillator, and Its Social Impact: A Community Health Study

Out-of-hospital cardiac arrest (OHCA) mortality remains high. The best survival rates are achieved when trained people provide OHCA victims with cardiopulmonary resuscitation (CPR); however, it is estimated that only 25% of victims receive CPR. This community health study aims to evaluate the effectiveness of a training programme in basic CPR and in the use of an automatic external defibrillator (AED) on knowledge and skills for lay people, and its social impact. The training courses were based on Catalan Council of Resuscitation guidelines. Data were collected on sociodemographic characteristics, evaluation of knowledge and practical skills at baseline and at the end of the training courses, and also on the social impact of the programme. A total of 36 training courses with 482 participants were carried out, and most participants achieved a qualification of suitable. The mean score in knowledge was 3.1 ± 1.1 at baseline and 3.8 ± 1.2 (p = 0.001) at the end of the programme. Participants rated the training courses as very satisfactory, considered the training useful, and felt more qualified to respond to an emergency. This study shows that a high percentage of participants acquired skills in basic CPR and use of an AED, which confirms the usefulness and effectiveness of training courses and its important social impact.

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

Background

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

Design

Intervention community study.

Methods

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

Results

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

Conclusions

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

The Silesian Registry of Out-of-Hospital Cardiac Arrest: Study design and results of a three-month pilot study

BACKGROUND

Despite the introduction of the concept known as "Chain of Survival" has significantly increased survival rates in patients with out-of-hospital cardiac arrest (OHCA), short-term mortality in this group of patients is still very high. Epidemiological data on OHCA in Poland are limited. The aim of this study was to create a prospective registry on OHCA covering a population of 2.7 million inhabitants of Upper Silesia in Poland. Presented herein is the study design and results of a 3-month pilot study.

METHODS

The Silesian Registry of Out-of-Hospital Cardiac Arrest (SIL-OHCA) is a prospective, population-based registry of OHCA, of minimum duration which was planned for 12 months; from January 1st, 2018 to December 31st, 2018. The first 3 months of the study constituted the pilot phase. The inclusion criterion is the occurrence of OHCA in the course of activity of the Voivodeship Rescue Service in Katowice, Poland.

RESULTS

During the 3-month pilot phase of the study there were 390 cases of OHCA in which cardiopulmonary resuscitation was undertaken. Estimated frequency of OHCA in the population analyzed was 57 per 100,000 population per year. Shockable rhythm was present in 25.8% of cases. Return of spontaneous circulation was achieved in 35.1% of the whole cohort. 28.7% of patients were admitted to the hospital, including 2.8% of patients, who were admitted during an ongoing cardiopulmonary resuscitation.

CONCLUSIONS

Prehospital survival of patients with OHCA in Poland is still unsatisfactory. It is believed that data collected in SIL-OHCA registry will allow identification factors, which require improvement in order to reduce short- and long-term mortality of patients with OHCA.

Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen

BACKGROUND

Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described.

AIM

To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA).

METHODS

This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel).

RESULTS

During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p<0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002).

CONCLUSIONS

In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.

Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study

BACKGROUND

Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome.

METHODS

Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts.

RESULTS

The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety.

CONCLUSION

Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

Telephone-assisted CPR: A literature review

Introduction

Despite numerous efforts, out-of-hospital cardiac arrest (OHCA) survival has not significantly increased in recent decades. The first telephone-assisted cardiopulmonary resuscitation (T-CPR) studies were published in the 1980s, but only in the last decade has T‑CPR been implemented in dispatch centers. T‑CPR is still not available in all dispatch centers and no national or international T‑CPR recommendations are available.

Methods

Studies from PubMed were identified and evaluated. Preliminary information from the European Dispatch Center Survey (EDiCeS) is also included.

Results

In all, 42 studies were included. T‑CPR is implemented in 87.6 % of those dispatch centers which have joined the not-yet published EDiCeS. According to German Resuscitation Registry data, about 10 % of OHCA patients received T‑CPR in 2014. Agonal breathing is the leading cause for nonrecognition of OHCA by the dispatcher. Sensitivity of OHCA recognition by the dispatcher is about 75 %, whereby 8–45 % of these patients were not in cardiac arrest. The time interval from call to first compression is 140–328 s. Instructing rescue breathing by telephone is time consuming, leads to extensive hands-off times, and often to ineffective ventilation; therefore, rescue breathing is not indicated in adults with primary cardiac arrest. Studies showed improved survival with standardized T‑CPR implementation.

Conclusion

T-CPR is established in many dispatch centers. However, emergency call interrogation and T‑CPR vary between dispatch centers and are often performed without evaluation. International recommendations with standardized quality control are necessary and may lead to improved survival.

Mortality in Spanish pediatric emergency departments: a 5-year multicenter survey

BACKGROUND

Analysis of the causes of death in children in the pediatric emergency department (ED) may aid the development of management and prevention practices.

OBJECTIVE

To identify the causes of death in Spanish pediatric EDs and to analyze the management of these children in the prehospital and hospital settings.

METHODS

This was a retrospective descriptive multicenter survey including all patients whose death was certified in 18 Spanish pediatric EDs between 2008 and 2013.

RESULTS

During the study period, 3 542 426 episodes were registered in the EDs. Of these, 54 patients died (mortality rate: 1.5/100 000 visits). Data of 53 patients are analyzed (male 36, 67%, 31 younger than 2 years old and 43.3% nonpreviously healthy children). The main causes of death were related to their previous illnesses (24.5%), sudden infant death syndrome (20.7%), and traumatism (18.8%).Prehospital cardiopulmonary resuscitation (CPR) was performed in 31 patients, and exclusively by health workers in 19 patients. In 35 patients, the parents witnessed the event and seven began CPR.Thirty children were transferred to the pediatric EDs by medical transport (56.6%) and all of them received prehospital CPR (vs. one patient out of 23 arrived in a nonmedical transportation).In 37 patients, CPR was performed in the pediatric EDs. Overall, CPR lasted 40±23 min (range, 10-120 min). CPR was not performed in seven patients at any time.

CONCLUSION

The main causes of death in Spanish pediatric EDs are related to previous illnesses, sudden infant death syndrome, and nonintentional lesions. Several actions have to be considered to improve the quality of care of these children in prehospital and emergency settings.

[Knowledge and attitudes of citizens in the Basque Country (Spain) towards cardiopulmonary resuscitation and automatic external defibrillators]

AIM

To explore the training, ability and attitudes towards cardiopulmonary resuscitation and the use of automatic defibrillators among the population of the Basque Country (Spain).

DESIGN

A face-to-face survey.

SCOPE

Capital cities of the Basque Country.

PARTICIPANTS

A total of 605 people between 15-64 years of age were randomly selected.

MAIN VARIABLES OF INTEREST

Information about the knowledge, perceptions and self-perceived ability to identify and assist cardiopulmonary arrest was requested.

RESULTS

A total of 56.4% of the responders were women, 61.8% were occupationally active, and 48.3% had higher education. Thirty-seven percent of the responders claimed to be trained in resuscitation techniques, but only 20.2% considered themselves able to apply such techniques. Public servants were almost 4 times more likely of being trained in defibrillation compared to the rest of workers (OR 3.7; P<.001), while people with elementary studies or no studies were almost 3 times more likely of not being trained in cardiopulmonary resuscitation, in comparison with the rest (OR 2.7; P=.001). A total of 94.7% of the responders considered it "quite or very important" for the general population to be able to apply resuscitation, though 55% considered themselves unable to identify an eye witnessed cardiac arrest, and 40.3% would not recognize a public-access defibrillator.

CONCLUSIONS

Citizens of the Basque Country consider the early identification and treatment of cardiorespiratory arrest victims to be important, though their knowledge in cardiopulmonary resuscitation and defibrillation is limited.

Cardiopulmonary resuscitation and automatic external defibrillator training in schools: "is anyone learning how to save a life?"

OBJECTIVES

Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED), save lives in cardiac arrest cases. School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. The study objective was to determine the rates of CPR and AED training in Toronto secondary schools and to identify barriers to training and training techniques.

METHODS

This prospective study consisted of telephone interviews conducted with key school staff knowledgeable about CPR and AED teaching. An encrypted Web-based tool with prespecified variables and built-in logic was employed to standardize data collection.

RESULTS

Of 268 schools contacted, 93% were available for interview and 83% consented to participate. Students and staff were trained in CPR in 51% and 80% of schools, respectively. Private schools had the lowest training rate (39%). Six percent of schools provided AED training to students and 47% provided AED training to staff. Forty-eight percent of schools had at least one AED installed, but 25% were unaware if their AED was registered with emergency services dispatch. Cost (17%), perceived need (11%), and school population size (10%) were common barriers to student training. Frequently employed training techniques were interactive (32%), didactic instruction (30%) and printed material (16%).

CONCLUSIONS

CPR training rates for staff and students were moderate overall and lowest in private schools, whereas training rates in AED use were poor in all schools. Identified barriers to training include cost and student population size (perceived to be too small to be cost-effective or too large to be implemented). Future studies should assess the application of convenient and cost-effective teaching alternatives not presently in use.

Temporal trends in out-of-hospital cardiac arrest survival outcomes between two metropolitan communities: Seoul-Osaka resuscitation study

OBJECTIVES

The objective of this study was to compare the temporal trends in survival after out-of-hospital cardiac arrest (OHCA) between two large metropolitan communities in Asia and evaluate the factors affecting survival after OHCA.

DESIGN

A population-based prospective observational study.

SETTING

The Cardiovascular Disease Surveillance (CAVAS) project in Seoul and the Utstein Osaka Project in Osaka.

PARTICIPANTS

A total of 36,292 resuscitation-attempted OHCAs with cardiac aetiology from 2006 to 2011 in Seoul and Osaka (11,082 in Seoul and 25,210 in Osaka).

PRIMARY OUTCOME MEASURES

The primary outcome was neurologically favourable survival. Trend analysis and multivariable Poisson regression models were conducted to evaluate the temporal trends in survival of two communities.

RESULTS

During the study period, the overall neurologically favourable survival was 2.6% in Seoul and 4.6% in Osaka (p<0.01). In both communities, bystander cardiopulmonary resuscitation (CPR) rates increased significantly from 2006 to 2011 (from 0.1% to 13.1% in Seoul and from 33.3% to 41.7% in Osaka). OHCAs that occurred in public places increased in Seoul (12.5% to 20.1%, p for trend <0.01) and decreased in Osaka (13.5% to 10.5%, p for trend <0.01). The proportion of OHCAs defibrillated by emergency medical service (EMS) providers was only 0.4% in 2006 but increased to 17.5% in 2011 in Seoul, whereas the proportion in Osaka decreased from 17.7% to 13.7% (both p for trend <0.01). Age-adjusted and gender-adjusted rates of neurologically favourable survival increased significantly in Seoul from 1.4% in 2006 to 4.3% in 2011 (adjusted rate ratio per year, 1.17; p for trend <0.01), whereas no significant improvement was observed in Osaka (3.6% in 2006 and 5.1% in 2011; adjusted rate ratio per year, 1.03; p for trend=0.08).

CONCLUSIONS

Survivals after OHCA were increased in Seoul while remained constant in Osaka, which may have been affected by the differences and improvements of patient, community, and EMS system factors.

[Teaching basic life support to the general population. Alumni intervention analysis]

OBJECTIVES

The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out.

DESIGN

A descriptive, cross-sectional study was made.

SETTING

A district in the province of Almería (Spain).

PATIENTS

Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009.

INTERVENTIONS

In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation.

MAIN VARIABLES OF INTEREST

Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation.

RESULTS

A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age.

CONCLUSIONS

The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter?

OBJECTIVES

To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area.

METHODS

We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.

RESULTS

From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p<0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60-0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p<0.01). All results above remained consistent in the analyses by mean household income.

CONCLUSIONS

Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.

Medical students teaching cardiopulmonary resuscitation to middle school Brazilian students

BACKGROUND

Diseases of the circulatory system are the most common cause of death in Brazil. Because the general population is often the first to identify problems related to the circulatory system, it is important that they are trained. However, training is challenging owing to the number of persons to be trained and the maintenance of training.

OBJECTIVES

To assess the delivery of a medical-student led cardiopulmonary resuscitation (CPR) training program and to assess prior knowledge of CPR as well as immediate and delayed retention of CPR training among middle school students.

METHODS

Two public and two private schools were selected. CPR training consisted of a video class followed by practice on manikins that was supervised by medical students. Multiple choice questionnaires were provided before, immediately after, and at 6 months after CPR training. The questions were related to general knowledge, the sequence of procedures, and the method to administer each component (ventilation, chest compression, and automated external defibrillation). The instructors met in a focus group after the sessions to identify the potential problems faced.

RESULTS

In total, 147 students completed the 6-month follow-up. The public school students had a lower prior knowledge, but this difference disappeared immediately after training. After the 6-month follow-up period, these public school students demonstrated lower retention. The main problem faced was teaching mouth-to-mouth resuscitation.

CONCLUSIONS

The method used by medical students to teach middle school students was based on the see-and-practice technique. This method was effective in achieving both immediate and late retention of acquired knowledge. The greater retention of knowledge among private school students may reflect cultural factors.

Four-stage teaching technique and chest compression performance of medical students compared to conventional technique

AIM

To compare the 2-stage and 4-stage basic life support teaching technique. The second aim was to test if students' self-evaluated knowledge was in accordance with their actual knowledge.

METHODS

A total of 126 first-year students of the Faculty of Medicine in Ljubljana were involved in this parallel study conducted in the academic year 2009/2010. They were divided into ten groups. Five groups were taught the 2-stage model and five the 4-stage model. The students were tested in a scenario immediately after the course. Questionnaires were filled in before and after the course. We assessed the absolute values of the chest compression variables and the proportions of students whose performance was evaluated as correct according to our criteria. The results were analyzed with independent samples t test or Mann-Whitney-U test. Proportions were compared with χ(2) test. The correlation was calculated with the Pearson coefficient.

RESULTS

There was no difference between the 2-stage (2S) and the 4-stage approach (4S) in the compression rate (126±13 min-1 vs 124±16 min -1, P=0.180, independent samples t test), compression depth (43±7 mm vs 44±8 mm, P=0.368, independent samples t test), and the number of compressions with correct hand placement (79±32% vs 78±12, P=0.765, Mann-Whitney U-test). However, students from the 4-stage group had a significantly higher average number of compressions per minute (70±13 min -1 2S, 78±12 min-1 4S, P=0.02, independent samples t test). The percentage of students with all the variables correct was the same (13% 2S, 15% 4S, P=0.741, χ2 test). There was no correlation between the students' actual and self-evaluated knowledge (P=0.158, Pearson coefficient=0.127).

CONCLUSIONS

The 4-stage teaching technique does not significantly improve the quality of chest compressions. The students' self-evaluation of their performance after the course was too high.

Improving bystander cardiopulmonary resuscitation

PURPOSE OF REVIEW

Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR.

RECENT FINDINGS

Given the host of barriers, a successful strategy to improve bystander CPR must enable more timely and comprehensive arrest identification, encourage and empower bystanders to act, and help assure effective CPR. Arrest identification can be simplified so that bystanders should start CPR when a person is unconscious and not breathing normally. Evidence from observational studies and interventional trials supports the effectiveness of chest compression-only CPR for bystanders. As a consequence, the emphasis of bystander CPR training has been modified to feature and assure chest compressions. Bystanders should initiate CPR with compressions and consider the addition of rescue breathing based on their CPR training and skills as well as special circumstances of the victim. Bystander CPR training has evolved to incorporate this emphasis. Although general community-level CPR training remains a cornerstone strategy, training directed to those most likely to witness an arrest also has a useful role. In particular, 'just-in-time' dispatcher-assisted CPR instruction can increase bystander CPR and improve the likelihood of survival.

SUMMARY

Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.

Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region

AIM OF THE STUDY

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the western world. We wanted to study changes in survival over time and factors linked to this in a region which have already reported high survival rates.

METHODS

We used a prospectively collected Utstein template database to identify all resuscitation attempts in adult patients with OHCA of presumed cardiac origin. We included 846 resuscitation attempts and compared survival to discharge with good outcome in two time periods (2001-2005 vs. 2006-2008).

RESULTS

We found no significant differences between the two time periods for mean age (71 and 70 years (p=0.309)), sex distribution (males 70% and 71% (p=0.708)), location of the OHCA (home 64% and 63% (p=0.732)), proportion of shockable rhythms (44% and 47% (p=0.261)) and rate of return of spontaneous circulation (38% and 43% (p=0.136)), respectively. Bystander cardiopulmonary resuscitation (CPR), however, increased significantly from 60% to 73% (p<0.0001), as did the overall rate of survival to discharge from 18% to 25% (p=0.018). In patients with a shockable first rhythm, rate of survival to discharge increased significantly from 37% to 48% (p=0.036). In witnessed arrest with shockable rhythm survival to discharge increased from 37% to 52% (p=0.0105).

CONCLUSION

Overall, good outcome is now achievable in every fourth resuscitation attempt and in every second resuscitation attempt when patients have a shockable rhythm. The reason for the better outcomes is most likely multi-factorial and linked to improvements in the local chain of survival.