Evolution and revolution in cardiopulmonary resuscitation

Factors analysis of lower probability of receiving bystander CPR in females: a web-based survey

BACKGROUND

Women are less likely to receive bystander cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrest (OHCA) compared to men. This study aims to identify the factors influencing the willingness to perform CPR on women, providing insights to improve training and public awareness.

METHODS

A cross-sectional web-based survey was conducted among medical and non-medical populations in southeastern China. The questionnaire assessed demographics, CPR training experience, and attitudes toward gender-related CPR concerns. A total of 450 responses were collected, with 433 valid responses included after quality control. Statistical analyses were performed using R4.3.2 to evaluate the impact of gender, age, occupation, and education on CPR willingness.

RESULTS

Women exhibited a higher willingness to perform CPR on female victims compared to men. Many male respondents hesitated due to concerns about physical contact, particularly regarding removing clothing during resuscitation. Younger individuals (18-35 and 36-50 years) showed greater willingness to provide CPR than older respondents (51-75 years), who were more cautious due to privacy concerns and traditional beliefs. Healthcare professionals and non-medical workers were more likely to perform CPR than medical students, who, despite receiving CPR training, expressed hesitation due to a lack of confidence and practical experience. Higher education levels were associated with increased willingness to perform CPR on women, with postgraduate respondents being the most willing. Additionally, most participants had never practiced on female CPR mannequins, despite widespread support-especially among women-for incorporating female models into training.

CONCLUSION

The lower likelihood of women receiving CPR is influenced by gender bias, societal norms, and training limitations. Addressing this issue requires public education to eliminate gender-based hesitation, improvements in CPR training programs to include female mannequins, and enhanced legal protections to reduce rescuer concerns. These measures can be combined with other key factors such as community-wide CPR training programs and increasing the availability of automated external defibrillators (AEDs) to help promote equity in access to life-saving interventions. Targeted interventions can promote gender equity in emergency response, ultimately improving survival outcomes for women.

Trends in major intensive care medicine journals: A machine learning approach

PURPOSE

Intensive care medicine (ICM) has the particularity of being a multidisciplinary specialty and its literature reflects this multidisciplinarity. However, the proportion of each field in this literature and its trend dynamics are not known. The objective of this study was to analyze the ICM literature, extract latent topics and search for the presence of research trends.

MATERIAL AND METHODS

Abstracts of original articles from the top ICM journals, from their inception until December 31st, 2019, were included. This corpus was fed into a structural topic modeling algorithm to extract latent semantic topics. The temporal distribution was then analyzed and the presence of trends was searched by Mann-Kendall trends tests.

RESULTS

Finally, 49,276 articles from 10 journals were included. After topic modeling analysis and experts' feedback, 124 research topics were selected and labeled. Topics were categorized into 19 categories, the most represented being respiratory, fundamental and neurological research. Increasing trends were observed for research on mechanical ventilation and decreasing trends for cardiopulmonary resuscitation.

CONCLUSIONS

This study reviewed all articles from major ICM journals in a comprehensive way. It provides a better understanding of ICM research landscape by analyzing the temporal evolution of latent research topics in the ICM literature.

Quality Evaluation Algorithm for Chest Compressions Based on OpenPose Model

Aiming at the problems of the low evaluation efficiency of the existing traditional cardiopulmonary resuscitation (CPR) training mode and the considerable development of machine vision technology, a quality evaluation algorithm for chest compressions (CCs) based on the OpenPose human pose estimation (HPE) model is proposed. Firstly, five evaluation criteria are proposed based on major international CPR guidelines along with our experimental study on elbow straightness. Then, the OpenPose network is applied to obtain the coordinates of the key points of the human skeleton. The algorithm subsequently calculates the geometric angles and displacement of the selected joint key points using the detected coordinates. Finally, it determines whether the compression posture is standard, and it calculates the depth, frequency, position and chest rebound, which are the critical evaluation metrics of CCs. Experimental results show that the average accuracy of network behavior detection reaches 94.85%, and detection speed reaches 25 fps.

Worldviews on Evidence-Based Cardiopulmonary Resuscitation Using a Novel Method

The evaluation of scientific content by researchers, as well as the knowledge networks and working groups of cardiopulmonary resuscitation, can help to improve and expand new scientific evidence in this field. The aim of this study was to identify the global scientific publications on cardiopulmonary resuscitation research using a novel method. The method used was based on obtaining bibliographic data automatically from scientific publications through the use of the Scopus Database API Interface. A total of 17,917 results were obtained, with a total of 60,226 reports and 53,634 authors. Six categories were detected with 38.56% corresponding to cardiac arrest, 21.8% to cardiopulmonary resuscitation, 17.16% to life-support training and education, 12.45% to ethics and decision-making in cardiac arrest, 4.77% to therapeutic treatment, and 3.72% to life-support techniques. Analyzing and identifying the main scientific contributions to this field of study can make it possible to establish collaboration networks and propose new lines of research, as well as to unify criteria for action. Future research should delve into the analyses of the other elements involved in this area.

Survival after in-hospital cardiopulmonary resuscitation from 2003 to 2013: An observational study before legislation on the life-sustaining treatment decision-making act of Korean patients

We analyzed cardiopulmonary resuscitation (CPR) rates, deaths preceded by CPR, and survival trends after in-hospital CPR, using a sample of nationwide Korean claims data for the period 2003 to 2013.The Korean National Health Insurance Service-National Sample Cohort is a stratified random sample of 1,025,340 subjects selected from among approximately 46 million Koreans. We evaluated the annual incidence of CPR per 1000 admissions in various age groups, hospital deaths preceded by CPR, and survival rate following in-hospital CPR. Analyses of the relationships between survival and patient and hospital characteristics were performed using logistic regression analysis.A total of 5918 in-hospital CPR cases from 2003 to 2013 were identified among eligible patients. The cumulative incidence of in-hospital CPR was 3.71 events per 1000 admissions (95% confidence interval 3.62-3.80). The CPR rate per 1000 admissions was highest among the oldest age group, and the rate decreased throughout the study period in all groups except the youngest age group. Hospital deaths were preceded by in-hospital CPR in 18.1% of cases, and the rate decreased in the oldest age group. The survival-to-discharge rate in all study subjects was 11.7% during study period, while the 6-month and 1-year survival rates were 8.0% and 7.2%, respectively. Survival tended to increase throughout the study period; however, this was not the case in the oldest age group. Age and malignancy were associated with lower survival rates, whereas myocardial infarction and diabetes mellitus were associated with higher survival rates.Our result shows that hospital deaths were preceded by in-hospital CPR in 18.1% of case, and the survival-to-discharge rate in all study subjects was 11.7% during the study period. Survival tended to increase throughout the study period except for the oldest age group. Our results provide reliable data that can be used to inform judicious decisions on the implementation of CPR, with the ultimate goal of optimizing survival rates and resource utilization.

A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

Background

A decision to refrain from cardiopulmonary resuscitation (CPR) in the case of cardiac arrest is recommended in terminally ill patients to avoid unnecessary suffering at time of death. The aim of this study was to describe the frequency of decisions and documentation of “do not attempt cardiopulmonary resuscitation” (DNACPR) in two Medical Home Care Units in Stockholm. Unit A had written guidelines about how to document CPR-decisions in the medical records, including a requirement for a decision to be taken (CPR: yes/no) while Unit B had no such requirement.

Method

The medical records for all patients in palliative phase of their disease at the two Units were reviewed. Data was collected on documentation of decisions about CPR (yes/no), DNACPR-decisions and documentation regarding whether the patient or next-of-kin had been informed about the DNACPR-decision.

Results

In the two Units, 316 and 219 patients in palliative phase were identified. In Unit A 100% of the patients had a CPR-decision (yes/no) compared to 79% in Unit B (p < 0.001). There was no statistically significant difference in DNACPR-decisions between the two Units, 43 and 37%. Documentation about informing the patient regarding the decision was significantly higher in Unit A, 53% compared to 14% at Unit B (p < 0.001). Documentation about informing the next-of-kin was also significantly higher at Unit A; 42% compared to 6% at Unit B (p < 0.001).

Conclusion

Less than 50% of patients in palliative phase had a decision of DNACPR in two Medical Home Care Units in Stockholm. The presence of written guidelines and a requirement for a CPR-decision did not increase the frequency of DNACPR-decisions but was associated with a higher frequency of documentation of decisions and of information given to both the patients and the next-of-kin.