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Altuwaijri F, Alrabiah A, Alqarni A, Habash AK, Alghofili M, Alotaibi O, Altuwaijri M. Comparison Between the Advanced Cardiac Life Support and Adult Advanced Life Support Protocols: A Simulation-Based Pilot Study. Emerg Med Int 2024; 2024:6696879. [PMID: 39464638 PMCID: PMC11511593 DOI: 10.1155/2024/6696879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/14/2024] [Accepted: 09/14/2024] [Indexed: 10/29/2024] Open
Abstract
Introduction: Cardiac arrest is a public health concern associated with unfavorable disease outcomes. Cardiopulmonary resuscitation (CPR) of optimal quality is widely acknowledged as an indispensable technique in restoring spontaneous circulation. In order to perform advanced cardiac life support (ACLS), chest compression must be paused twice: once to assess the rhythm and again to administer the shock. Australian advanced life support (ALS) recommends that the defibrillator needs to be precharged in order to administer the shock during a solitary interval in chest compressions. While performing chest compressions, precharging defibrillators can decrease hands-off time without posing a risk of injury. Aim: To compare chest compression fraction (CCF)-which is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation-by calculating the hands-off time duration in cardiac arrest between the Australian Resuscitation Council (ARC) and American Heart Association (AHA) protocols for CPR. Methods: A simulation-based pilot study was designed using a Laerdal Resusci Anne mannequin and a LIFEPACK 20 defibrillator. The study included six participants recruited from King Khalid University Hospital in Riyadh, Saudi Arabia, where three participants were certified ACLS providers and there were certified ALS providers. Participants were divided into two groups, ALS and ACLS, each following one protocol. For each scenario, a random job was assigned to each participant, regardless of their role as assistant, team leader, or performer of CPR. Each case's shockable and nonshockable rhythms were hidden from the team leader and the chest compressor. Ten trials of CPR were performed, each for four cycles with a total time of 8 min. The simulation was video recorded for hands-off time counting. Comparison between CCF (seconds) per cycle between the two protocols was performed using an independent sample t-test. A p value of 0.05 was used to measure statistical significance. Results: Comparing CCF in shockable rhythms between ARC and AHA protocols, it was observed that the CCF of ALS-ARC was significantly higher than ACLS-AHA in all cycles; the first cycle: t = 3.782, p=0.004; the second cycle: t = 3.380, p=0.007; the third cycle: t = 3.803, p=0.003; and the fourth cycle: t = 4.341, p=0.001. Conclusion: Precharging a defibrillator before a rhythm check during chest compression, in anticipation of a potentially shockable rhythm, reduces the time required for defibrillation and limits interruptions in chest compression during CPR. This practice effectively enhances the CCF. Enhancing the continuity of chest compressions can potentially improve survival rates in ARC.
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Affiliation(s)
- Fawaz Altuwaijri
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alrabiah
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alqarni
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alia Kamal Habash
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alghofili
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Omar Alotaibi
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Wang JY, Chen Y, Dong R, Li S, Peng JM, Hu XY, Jiang W, Wang CY, Weng L, Du B. Extracorporeal vs. conventional CPR for out-of-hospital cardiac arrest: A systematic review and meta-analysis. Am J Emerg Med 2024; 80:185-193. [PMID: 38626653 DOI: 10.1016/j.ajem.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality and morbidity worldwide. Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential intervention for OHCA, but its effectiveness compared to conventional cardiopulmonary resuscitation (CCPR) needs further evaluation. METHOD We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from January 2010 to March 2023. Pooled meta-analysis was performed to investigate any potential association between ECPR and improved survival and neurological outcomes. RESULTS This systematic review and meta-analysis included two randomized controlled trials enrolling 162 participants and 10 observational cohort studies enrolling 4507 participants. The pooled meta-analysis demonstrated that compared to CCRP, ECPR did not improve survival and neurological outcomes at 180 days following OHCA (RR: 3.39, 95% CI: 0.79 to 14.64; RR: 2.35, 95% CI: 0.97 to 5.67). While a beneficial effect of ECPR was obtained regarding 30-day survival and neurological outcomes. Furthermore, ECPR was associated with a higher risk of bleeding complications. Subgroup analysis showed that ECPR was prominently beneficial when exclusively initiated in the emergency department. Additional post-resuscitation treatments did not significantly impact the efficacy of ECPR on 180-day survival with favorable neurological outcomes. CONCLUSIONS There is no high-quality evidence supporting the superiority of ECPR over CCPR in terms of survival and neurological outcomes in OHCA patients. However, due to the potential for bias, heterogeneity among studies, and inconsistency in practice, the non-significant results do not preclude the potential benefits of ECPR. Further high-quality research is warranted to optimize ECPR practice and provide more generalizable evidence. Clinical trial registration PROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42023402211.
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Affiliation(s)
- Jing-Yi Wang
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Chen
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Run Dong
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Li
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jin-Min Peng
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Yun Hu
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Jiang
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Yao Wang
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Li Weng
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
| | - Bin Du
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
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Sood N, Sangari A, Goyal A, Sun C, Horinek M, Hauger JA, Perry L. Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis. World J Cardiol 2023; 15:531-541. [PMID: 37900903 PMCID: PMC10600786 DOI: 10.4330/wjc.v15.i10.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA. METHODS We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05. RESULTS Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047]. CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.
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Affiliation(s)
- Nitish Sood
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
| | - Anish Sangari
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Arnav Goyal
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Christina Sun
- Dental College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Madison Horinek
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Joseph Andy Hauger
- Department of Chemistry and Physics, Augusta University, Augusta, GA 30912, United States
| | - Lane Perry
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
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Marsh-Armstrong BP, Seng E, Ting-Wei F, Saka S, Greenberg M. Effectiveness of rescue Me CPR! smartphone app providing real-time guidance to untrained bystanders performing CPR. Heliyon 2023; 9:e20908. [PMID: 37867873 PMCID: PMC10589871 DOI: 10.1016/j.heliyon.2023.e20908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a persistent global health challenge, owing, in part, to low rates of population CPR training. Smartphone applications have the potential to widely disseminate CPR basic training to a populace, but other studies have found multiple limitations in previously developed CPR guidance applications (CPR-GA). This study aims to use medical simulation to assess the relative CPR performance of novices using the 'Rescue Me CPR!' (RMC) app, a custom CPR-GA designed by this research team, to novices using 'PG-CPR!' (PGC), the most downloaded CPR-GA available in the USA, and to CPR certified medical personnel. Methods In a prospective randomized experimental trial of 60 individuals, subjects were either given the RMC app, the PGC app, or had active CPR certification. They were presented a cardio-pulmonary arrest scenario and were observed while performing CPR on a high-fidelity manikin. Data was collected through four cycles of CPR, during which time 24 pertinent performance metrics and CPR steps were timed and recorded. These metrics were assessed on their own and used to calculate average time to compressions, average chest compression fraction, and rate of high-quality CPR for each study group. Results CPR certified subjects called 911 in 100 % of simulation cases, started compressions 34 ± 10 s after first seeing the simulated patient, had an average chest compression fraction of 0.52, and performed high-quality CPR in 25 % of aggregate compression cycles. PGC app users called 911 in 70 % of simulation cases, started compressions 86 ± 17 s after first seeing the simulated patient, had an average chest compression fraction that could not be assessed due to inconsistent pauses during CPR, and performed high-quality CPR in 2.5 % of aggregate compression cycles. RMC app users called 911 in 100 % of simulation cases, started compressions 55 ± 6 s after first seeing the simulated patient, had an average chest compression fraction of 0.48, and performed high-quality CPR in 50 % of aggregate compression cycles. Conclusion The results of this study demonstrate that in all studied metrics, except time-to-first-compression, CPR provided by individuals using the RMC app is statistically equivalent or superior to CPR performed by a CPR certified individual and, in almost every metric, superior to CPR performed by users of the most downloaded android CPR guidance application, PG-CPR.
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Affiliation(s)
| | - Eri Seng
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Fan Ting-Wei
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Stella Saka
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Mark Greenberg
- University of California San Diego, La Jolla, CA, 92037, USA
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Junli A, Isa SNI, Ibrahim FS. Factors of cardiopulmonary resuscitation skills retention among healthcare providers: A scoping review. Nurse Educ Pract 2023; 69:103617. [PMID: 36996552 DOI: 10.1016/j.nepr.2023.103617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The retention of cardiopulmonary resuscitation skills among healthcare providers is critical to ensure the delivery of effective treatment to patients who experience cardiac arrest. However, the factors influencing cardiopulmonary resuscitation skills retention among healthcare providers have yet to be well studied. OBJECTIVE This scoping review aimed to map the factors influencing cardiopulmonary resuscitation skills retention among healthcare providers. METHODS A literature search was conducted using the Web of Sciences, Scopus, Cochrane, Google Scholar and PubMed electronic databases. The inclusion criteria were original publications published during the last five years (2018 - 2022), availability of full texts in English and evidence of the retention of pertinent cardiopulmonary resuscitation in terms of knowledge and abilities. RESULTS Three cross-sectional studies, two prospective studies, one each of prospective descriptive-analytical study, randomised controlled trial, intervention and prospective interventional study, prospective pre-post study, retrospective study, cluster randomised control trial and randomised education trial study comprise the 14 publications including in this study. The thematic analysis identified four major themes that influence the retention of cardiopulmonary resuscitation skills: experience, training type, training frequency and other factors. The final theme identified infrastructure access, evidence-based practice review meetings and healthcare providers' educational background. CONCLUSION To retain skills in cardiopulmonary resuscitation, healthcare providers must be regularly updated and trained on the latest cardiopulmonary resuscitation guidelines.
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Affiliation(s)
- Amiruddin Junli
- Out-patient Department, Klinik Kesihatan Lahad Datu, Pejabat Kesihatan Kawasan Lahad Datu, 91120 Lahad Datu, Sabah, Malaysia; Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Siti Nor Ismalina Isa
- Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia; Integrated Nutrition Science and Therapy Research Group (INSPiRE), Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia.
| | - Farrah Shafeera Ibrahim
- Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
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Li F, Yang CP, Chang CH, Ho CA, Wu CY, Yeh HC, Hsu CW, Chang PJ, Ho CS. Effect of the Brief Instructional Video Intervention on the Quality of Cardiopulmonary Resuscitation. Int J Med Sci 2023; 20:70-78. [PMID: 36619233 PMCID: PMC9812805 DOI: 10.7150/ijms.79433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Chest compressions are the basis of cardiopulmonary resuscitation (CPR), and high-quality chest compressions can improve survival rate in patients with out-of-hospital cardiac arrest. Although many efforts have been made to improve the quality of CPR in inexperienced adults, the results are still not high, especially during emergencies. The primary purpose of this study is to investigate whether a brief instructional chest compression-only CPR video could improve chest compression quality in inexperienced adults. Methods: One hundred adults with no CPR experience (age: 20.28 ± 2.28 years; women: 50, men: 50) participated in this study. Participants completed body composition and handgrip strength measurements, and performed two CPR quality tests on the Laerdal® Little Anne QCPR Manikin, namely without video-CPR (WV-CPR) and video-CPR (V-CPR). The WV-CPR quality test was performed first. After 2 minutes of continuous chest compression, the participants rested for 10 seconds and repeated 3 cycles (phase 1, phase 2, and phase 3). After resting for more than 72 hours, V-CPR quality test was conducted. During the V-CPR with video intervention, the participants also continued to compress the chest for 2 minutes, and then rested for 10 seconds, repeating 3 cycles. Results: In phase 1, compared with WV-CPR, the V-CPR has a significant increase (p < 0.001) in chest compression fraction (CCF) (56.31 ± 33.22% vs. 41.82 ± 32.30%) and percent of correct compression rate (PCCR) (96.17 ± 8.45% vs. 26.31 ± 37.55%). In addition, the V-CPR has significantly lower (p < 0.001) chest compression rate (CCR) (110.85 ± 2.40 cpm vs. 128.86 ± 24.52 cpm) and rating of perceived exertion (RPE) (11.89 ± 2.25 vs. 12.87 ± 2.25). For phases 2 through 3, V-CPR and WV-CPR achieved significant differences in CCF, CCD, CCR, PCCR, and RPE (p < 0.01). There were significant differences (p < 0.05) in CCF, CCD, chest compression rebound rate, and RPE among the different administration stages of both WV-CPR and V-CPR. Conclusions: The results of this study revealed that a brief instructional chest compression-only CPR video could improve chest compression quality for inexperienced adults by reducing fatigue and CCR, and increasing CCF and PCCR.
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Affiliation(s)
- Fang Li
- School of Physical Education, Central China Normal University, Wuhan, China
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chun-Hao Chang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chia-An Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Cheng-You Wu
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Hung-Chih Yeh
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chun-Wei Hsu
- College of Exercise and Health Science, National Taiwan Sport University, Taoyuan City, Taiwan
| | | | - Chin-Shan Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
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Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth 2022; 22:159. [PMID: 35216559 PMCID: PMC8881850 DOI: 10.1186/s12884-021-04334-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. Results We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. Conclusions Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.
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Affiliation(s)
- Naosuke Enomoto
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomoyuki Yamashita
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Edmond S W Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynaecology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
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Saeed F, Murad HF, Wing RE, Li J, Schold JD, Fiscella KA. Outcomes Following In-Hospital Cardiopulmonary Resuscitation in People Receiving Maintenance Dialysis. Kidney Med 2022; 4:100380. [PMID: 35072044 PMCID: PMC8767126 DOI: 10.1016/j.xkme.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE & OBJECTIVE Previous studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis. STUDY DESIGN Retrospective chart review. SETTING & PARTICIPANTS Using electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014. EXPOSURE Initial in-hospital CPR. OUTCOMES Overall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status. ANALYTICAL APPROACH We provide descriptive statistics for the study variables and used t tests, χ2 tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes. RESULTS A total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; P < 0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; P = 0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; P < 0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; P < 0.001). LIMITATIONS Retrospective study design, single-center study, no information on functional status. CONCLUSIONS Patients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.
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Affiliation(s)
- Fahad Saeed
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Haris F. Murad
- Department of Medicine, Division of Nephrology, Washington University in St Louis, St Louis, MO
| | - Richard E. Wing
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jianbo Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH
| | - Kevin A. Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Miko A, Dalhat S, Mujahid H, Saheed A, Mohammad A, Sani A, Shuaibu I. Impact of basic life support training on the knowledge of cardiopulmonary resuscitation among final-year medical students. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Musiari M, Saporito A, Ceruti S, Biggiogero M, Iattoni M, Glotta A, Cantini L, Capdevila X, Cassina T. Can a Glove-Coach Technology Significantly Increase the Efficacy of Cardiopulmonary Resuscitation on Non-healthcare Professionals? A Controlled Trial. Front Cardiovasc Med 2021; 8:685988. [PMID: 34957226 PMCID: PMC8695546 DOI: 10.3389/fcvm.2021.685988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiovascular accidents are the world's leading cause of death. A good quality cardiopulmonary resuscitation (CPR) can reduce cardiac arrest-associated mortality. This study aims to test the coaching system of a wearable glove, providing instructions during out-of-hospital CPR. Materials and Methods: We performed a single-blind, controlled trial to test non-healthcare professionals during a simulated CPR performed on an electronic mannequin. The no-glove group was the control. The primary outcome was to compare the accuracy of depth and frequency of two simulated CPR sessions. Secondary outcomes were to compare the decay of CPR performance and the percentage of the duration of accurate CPR. Results: About 130 volunteers were allocated to 1:1 ratio in both groups; mean age was 36 ± 15 years (min-max 21-64) and 62 (48%) were men; 600 chest compressions were performed, and 571 chest compressions were analyzed. The mean frequency in the glove group was 117.67 vs. 103.02 rpm in the control group (p < 0.001). The appropriate rate cycle was 92.4% in the glove group vs. 71% in the control group, with a difference of 21.4% (p < 0.001). Mean compression depth in the glove group was 52.11 vs. 55.17 mm in the control group (p < 0.001). A mean reduction of compression depth over time of 5.3 mm/min was observed in the control group vs. 0.83 mm/min of reduction in the glove group. Conclusion: Visual and acoustic feedbacks provided through the utilization of the glove's coaching system were useful for non-healthcare professionals' CPR performance.
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Affiliation(s)
- Michele Musiari
- Department of Anaesthesiology, Fribourg Cantonal Hospital (HFR), Villars-sur-Glâne, Switzerland.,University Clinic for Anesthesiology and Pain Therapy Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Saporito
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Martina Iattoni
- Department of Internal Medicine, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Andrea Glotta
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Laura Cantini
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Xavier Capdevila
- Montpellier University Hospital, Department of Anaesthesia and Intensive Care, Montpellier, France
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Hajeb-Mohammadalipour S, Cascella A, Valentine M, Chon KH. Automated Condition-Based Suppression of the CPR Artifact in ECG Data to Make a Reliable Shock Decision for AEDs during CPR. SENSORS (BASEL, SWITZERLAND) 2021; 21:8210. [PMID: 34960308 PMCID: PMC8708115 DOI: 10.3390/s21248210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/11/2022]
Abstract
Cardiopulmonary resuscitation (CPR) corrupts the morphology of the electrocardiogram (ECG) signal, resulting in an inaccurate automated external defibrillator (AED) rhythm analysis. Consequently, most current AEDs prohibit CPR during the rhythm analysis period, thereby decreasing the survival rate. To overcome this limitation, we designed a condition-based filtering algorithm that consists of three stop-band filters which are turned either 'on' or 'off' depending on the ECG's spectral characteristics. Typically, removing the artifact's higher frequency peaks in addition to the highest frequency peak eliminates most of the ECG's morphological disturbance on the non-shockable rhythms. However, the shockable rhythms usually have dynamics in the frequency range of (3-6) Hz, which in certain cases coincide with CPR compression's harmonic frequencies, hence, removing them may lead to destruction of the shockable signal's dynamics. The proposed algorithm achieves CPR artifact removal without compromising the integrity of the shockable rhythm by considering three different spectral factors. The dataset from the PhysioNet archive was used to develop this condition-based approach. To quantify the performance of the approach on a separate dataset, three performance metrics were computed: the correlation coefficient, signal-to-noise ratio (SNR), and accuracy of Defibtech's shock decision algorithm. This dataset, containing 14 s ECG segments of different types of rhythms from 458 subjects, belongs to Defibtech commercial AED's validation set. The CPR artifact data from 52 different resuscitators were added to artifact-free ECG data to create 23,816 CPR-contaminated data segments. From this, 82% of the filtered shockable and 70% of the filtered non-shockable ECG data were highly correlated (>0.7) with the artifact-free ECG; this value was only 13 and 12% for CPR-contaminated shockable and non-shockable, respectively, without our filtering approach. The SNR improvement was 4.5 ± 2.5 dB, averaging over the entire dataset. Defibtech's rhythm analysis algorithm was applied to the filtered data. We found a sensitivity improvement from 67.7 to 91.3% and 62.7 to 78% for VF and rapid VT, respectively, and specificity improved from 96.2 to 96.5% and 91.5 to 92.7% for normal sinus rhythm (NSR) and other non-shockables, respectively.
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Affiliation(s)
| | | | | | - Ki H. Chon
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06269, USA;
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12
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Ślęzak D, Robakowska M, Żuratyński P, Synoweć J, Pogorzelczyk K, Krzyżanowski K, Błażek M, Woroń J. Analysis of the Way and Correctness of Using Automated External Defibrillators Placed in Public Space in Polish Cities-Continuation of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9892. [PMID: 34574815 PMCID: PMC8468203 DOI: 10.3390/ijerph18189892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Abstract
Immediate resuscitation is required for any sudden cardiac arrest. To improve the survival of the patient, a device to be operated by witnesses of the event-automated external defibrillator (AED)-has been produced. The aim of this study is to analyze the way and correctness of use of automated external defibrillators placed in public spaces in Polish cities. The data analyzed (using Excel 2019 and R 3.5.3 software) are 120 cases of use of automated external defibrillators, placed in public spaces in the territory of Poland in 2008-2018. The predominant location of AED use is in public transportation facilities, and the injured party is the traveler. AED use in non-hospital settings is more common in male victims aged 50-60 years. Owners of AEDs inadequately provide information about their use. The documentation that forms the basis of the emergency medical services intervention needs to be refined. There is no mention of resuscitation performed by a witness of an event or of the use of an AED. In addition, Poland lacks the legal basis for maintaining a register of automated external defibrillators. There is a need to develop appropriate documents to determine the process of reporting by the owners of the use of AEDs in out-of-hospital conditions (OHCA).
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Affiliation(s)
- Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | - Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (K.P.)
| | - Przemysław Żuratyński
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | | | - Katarzyna Pogorzelczyk
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (K.P.)
| | - Kamil Krzyżanowski
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (P.Ż.); (K.K.)
| | - Magdalena Błażek
- Division of Quality of Life Research, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Jarosław Woroń
- Department of Clinical Pharmacology, Jagiellonian University, 31-531 Kraków, Poland;
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13
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Righi FA, Jenkins S, Lin PT. Nonskeletal injuries related to cardiopulmonary resuscitation: An autopsy study. J Forensic Sci 2021; 66:2299-2306. [PMID: 34250595 DOI: 10.1111/1556-4029.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
The current standard technique for cardiopulmonary resuscitation (CPR), initially described in the early 1960s, has quickly become the expected response for all persons found without a pulse or respiration. Despite the potentially lifesaving properties of external cardiac massage, the mainstay of resuscitation, it consists of repeated blunt force trauma to the chest, which can lead to extensive traumatic skeletal and nonskeletal injuries. Numerous autopsy-based studies have documented the incidence and patterns of rib and sternal fractures associated with attempted CPR, but there is relatively little data on the incidence and severity of nonskeletal CPR-related injuries. We reviewed reports from 1878 autopsies performed between September 2017 and December 2019 (inclusive), for documentation of CPR-related injuries. Among these cases, there were 93 cases with resuscitation-related nonskeletal injuries. The most common type of injury identified were visceral contusions, documented in 57.0% of cases. These contusions predominantly involved the heart, lungs, neck soft tissue, and surrounding structures. Resuscitation-related lacerations were seen in 17.2% of the cases, most predominantly involving the pericardium, heart, and liver. Statistical analysis of the data demonstrated that lacerations were more likely to be seen in females and with associated sternal fractures. Additionally, hemothoraces were present in 34.4% of cases and hemopericardium was seen in 8.6% of cases. This study provides additional documentation of the range, severity, and incidence of various types of resuscitation-related visceral injuries to better assist autopsy pathologists in distinguishing these injuries from other antecedent traumatic injuries.
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Affiliation(s)
- Fabiola A Righi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Peter T Lin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Southern Minnesota Regional Medical Examiner Office, Rochester, MN, USA
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