Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Compression-only or standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials

This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA). We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane "Risk of Bias" tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model. A total of 4 randomized controlled trials were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR [relative risk (RR) 1.22, 95% confidence interval (CI): 1.01 to 1.46] with minimal heterogeneity (I2=0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (cerebral performance category 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25). This meta-analysis found that chest CO-CPR significantly improves survival to hospital discharge compared to sCPR for managing OHCA, while yielding comparable results for other resuscitation outcomes.

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.

Comparison of intelligent virtual reality first-aid training outcomes among individuals with different demographic characteristics

OBJECTIVE

To compare the outcomes of intelligent first-aid training based on virtual reality (VR) among individuals with different demographic characteristics.

METHODS

A total of 50 nonmedical professional volunteers from Nanchang were conveniently sampled in March 2021. All participants underwent intelligent VR first-aid training, and a comparative analysis was conducted by dividing them into different groups based on demographic characteristics.

RESULTS

Male participants had a lower chest compression interruption time compared to female participants (7.40 ± 0.50 vs. 8.04 ± 0.56, t = -4.231, p < 0.001). Additionally, male participants had a higher proportion of compressions with correct compression depth (81.33 ± 1.24 vs. 79.78 ± 1.48, t = 4.038, p < 0.001), higher mean ventilation volume (518.11 ± 1.50 vs. 516.61 ± 2.17, t = 2.881, p = 0.006), and higher theoretical knowledge test score (8.74 ± 0.59 vs. 8.00 ± 0.43, t = 4.981, p < 0.001). There were statistically significant differences in the mean chest compression frequency (110.38 ± 5.74 vs. 105.00 ± 4.78 vs. 107.80 ± 5.97, F = 5.187, p = 0.009) among participants with different educational backgrounds. Pairwise comparisons showed that technical degree holders had a higher mean chest compression frequency than bachelor's degree holders, whereas no statistically significant difference was observed between master's degree holders and bachelor's degree holders.

CONCLUSION

The outcomes of first-aid training differ among participants of different genders and with different educational backgrounds. With all participants meeting the training qualifications, it is believed that the application of intelligent VR first-aid training platforms can improve the first aid capabilities of the public.

BComparison of supraglottic airway device vs. endotracheal intubation for initial airway management in out-of-hospital cardiac arrest: a systematic review and meta-analysis

INTRODUCTION

Out-of-hospital cardiac arrest (OHCA) is characterized by the cessation of mechanical cardiac activity and voluntary circulation occurring outside of a hospital setting, making it the leading cause of death worldwide. Recently, the optimal approach to airway management has been a subject of controversy.

METHODS

Follow PRISMA guidelines for systematic evaluation and meta-analysis. The primary outcome was survival assessed by 4 measures: Restoration of spontaneous circulation, survival to hospital or emergency department, evaluation of functional recovery after PCR (measured at both discharge and 3 months after PCR), and neurological function score at discharge.

RESULTS

A total of 6 RCTs (14,205 patients) were included in the systematic review and 4 RCTs (13,053 patients) were included in the meta-analysis. 5 studies (83.3%)of RCTs with ETI controls were notable for their high quality, with low risk of bias judged in all 7 domains of the risk assessment scale. Showed an advantage of SGA (compared to ETI) with potential for ROSC (95% CI [1.02 to 1.18], I2 = 48%, p = 0.01) and survival to hospital or emergency department(95% CI [1.01 to 1.17], I2 = 12%, p = 0.02).

CONCLUSIONS

This systematic review and meta-analysis found a significant association between SGA and the possibility of obtaining ROSC and reaching the hospital or emergency department after CPR in OHCA.

Actions Taken by Bystanders During Sudden Cardiac Arrest: Analysis of Emergency Medical Service Documentation in Poland

Background/Objectives: Sudden cardiac arrest (SCA) is a severe medical condition involving the cessation of the heart's mechanical activity. Following the chain of survival, which includes early recognition and calling for help, early initiation of cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care, offers the greatest chances of saving a person who has experienced SCA. The aim of this study was to analyze cases of out-of-hospital cardiac arrest (OHCA) and assess the actions taken by bystanders. Methods: The input for analysis consisted of 49,649 dispatch records from the emergency medical team (EMT) at the Voivodeship Emergency Medical Station in Bialystok in 2018-2019. Results: Among the patients where bystanders performed CPR, the return of spontaneous circulation (ROSC) occurred in 30.53% of cases, whereas in the cases where the bystander did not perform CPR, ROSC occurred in 2.35% of cases. When cardiac arrest rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), ROSC occurred in 58.62% of cases, while there was asystole or pulseless electrical activity (PEA) present, ROSC occurred in 26.56% of cases. In patients who experienced OHCA in a VF/pVT rhythm and who underwent intubation, ROSC occurred in 58.73% of cases, whereas in patients who underwent alternative procedures for airway management, ROSC occurred in 83.33% of cases. Conclusions: The most significant factor influencing the occurrence of ROSC in patients is CPR initiation by bystanders. The presence of a rhythm that requires defibrillation increases the likelihood of achieving ROSC in the patient. Alternative methods for airway management appear to be more beneficial in VF/pVT rhythms.

[Role of German cardiac arrest centers in mediating basic life support]

BACKGROUND AND OBJECTIVE

Despite a measurable increase in recent years, the bystander resuscitation rate in Germany lags behind the European comparison. Special centers for the care of patients after cardiac arrest, so-called cardiac arrest centers (CAC), have been established. The aim of this work is to evaluate the role of CACs, in addition to in-hospital patient care, in improving the bystander resuscitation rate in Germany and what obstacles exist in the implementation of resuscitation training.

MATERIALS AND METHODS

Online survey by the working group cardiopulmonary resuscitation (AG42) of the German Society of Cardiology (DGK) and the German Resuscitation Council (GRC) RESULTS: Of the 74 participating clinics (78.4% certified as CAC), 23 (31.1%) conduct lay resuscitation training. These mainly take place within the framework of action days for resuscitation (82.6%) or in schools (39.1%). Permanent cooperation with at least one school existed in 52.2%. Basic life support (BLS) resuscitation dummies are available in 63.5% of these clinics and an automated external defibrillator (AED) demonstration device in 43.2%. According to the interviewees, the biggest obstacles to the consistent implementation of resuscitation courses in schools include lack of qualified instructors, lack of refinancing and difficulties with regard to coordinating activities between schools and providers.

CONCLUSIONS

Direct training of lay rescuers by hospitals faces several obstacles. To increase the bystander resuscitation rate, focusing on targeted training of teachers as multipliers (train-the-trainer) can be a good approach for cardiac arrest centers.

Application Effect of the China Association For Disaster and Emergency Rescue Medicine - Cardiopulmonary Resuscitation and Automatic Extracorporeal Defibrillation (CADERM-CPR·D) Training in Medical Teaching

Objective In China, the penetration rate of cardiopulmonary resuscitation training is not high and the effect of traditional teaching methods is not good. In this study, the case-guided cardiopulmonary resuscitation training mode was introduced to provide cardiopulmonary resuscitation training to medical students with a certain medical background, using the 2018 technical specifications for cardiopulmonary resuscitation and automatic extracorporeal defibrillation of the China Association for Disaster and Emergency Rescue Medicine. Compared with traditional teaching methods, the application effect of this training method in clinical probation teaching was analyzed. Methods 120 medical students with a certain medical background were randomly divided into the experimental group and the control group, with 60 students in each group. The knowledge, skills, and attitude of the subjects were assessed by questionnaire survey. Results A total of 120 students were included in the study and randomly divided into an experimental group and a control group. The test scores of knowledge, skill, and attitude in the experimental group (38.40±2.775, 19.07±1.118, 14.92±0.962) were significantly higher than those in the control group (32.47±3.615, 14.65±1.338, 12.68±0.930)(P<0.05). Conclusion Case-guided cardiopulmonary resuscitation training of the China Association for Disaster and Emergency Rescue Medicine specifications can improve medical students' knowledge and skills of cardiopulmonary resuscitation, enhance their confidence in treatment, and can be further applied in medical teaching.

Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons

AIM

We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons.

METHODS

This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR.

RESULTS

In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13-1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively.

CONCLUSIONS

In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest

This study aimed to evaluate the effects of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR (DA-CPR) on outcomes after out-of-hospital cardiac arrest (OHCA). We conducted a prospective observational study using the Korean Cardiac Arrest Research Consortium registry database and enrolled adults aged > 20 years who sustained OHCA. The study population comprised 13,864 patients from October 1, 2015, to June 30, 2021. All enrolled patients were transported to the emergency room and resuscitated by the emergency medical personnel. Patients with terminal illnesses, pregnancy, "do not resuscitate" cards, and insufficient recorded information were excluded. Good neurologic outcomes were noted in 6.5%, 9.9%, and 9.6% of patients in the "no bystander", "standard bystander", and "compression-only bystander" CPR groups, respectively, and differed significantly (p < 0.001). Survival to discharge differed significantly (p < 0.001) between groups at 10.8%, 13.1%, and 13.2%, respectively. In a multivariable model, the interaction between "compression-only" and DA-CPR showed a positive effect on good neurological outcomes and survival to discharge with an odds ratio of 1.93 (Confidence interval, CI 1.28-2.91, p = 0.002) and 1.74 (CI 1.24-2.44, p = 0.001), respectively. In conclusion, the interaction between compression-only CPR and DA-CPR is significantly associated with good neurological and survival outcomes after OHCA. Education for bystanders and dispatchers should adhere to the current guidelines to improve outcomes among OHCA victims.