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López-Herce J, Manrique I. Novelties in pediatric cardiopulmonary resuscitation recommendations. An Pediatr (Barc) 2024; 100:e25-e26. [PMID: 38580590 DOI: 10.1016/j.anpede.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 04/07/2024] Open
Affiliation(s)
- Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid, Spain.
| | - Ignacio Manrique
- Instituto Valenciano de Pediatría, Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal, Spain
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Vaillancourt C, Charette M, Khorsand S, Shligold E, Lanos C, Dale-Tam J, Tran A, Boyle L, Aucoin S, Maniate J, Meggison H, Hartwick M, Posner G. Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest. Resuscitation 2024; 198:110172. [PMID: 38461888 DOI: 10.1016/j.resuscitation.2024.110172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE We sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge. METHODS We completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA. RESULTS There were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052). CONCLUSIONS The COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | | | - Soha Khorsand
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Chelsea Lanos
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Alexandre Tran
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, ON, Canada; Division of Critical Care Medicine, University of Ottawa, ON, Canada
| | - Loree Boyle
- Department of Medicine, University of Ottawa, ON, Canada
| | - Sylvie Aucoin
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - Jerry Maniate
- Department of Medicine, University of Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
| | - Hilary Meggison
- Division of Critical Care Medicine, University of Ottawa, ON, Canada
| | - Michael Hartwick
- Division of Critical Care Medicine, University of Ottawa, ON, Canada
| | - Glenn Posner
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, ON, Canada
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Bradfield M, Haywood KL, Mion M, Kayani A, Leckey S. Not just surviving: Towards a quality standard which meets the care and rehabilitation needs of cardiac arrest survivors and their key supporters. Resuscitation 2024; 198:110182. [PMID: 38492715 DOI: 10.1016/j.resuscitation.2024.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Affiliation(s)
- M Bradfield
- Resuscitation Council UK, United Kingdom; Faculty of Health and Social Sciences, Bournemouth University, Dorset, United Kingdom; RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom.
| | - K L Haywood
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, United Kingdom
| | - M Mion
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom; Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - A Kayani
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom
| | - S Leckey
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Northern Ireland Ambulance Service, Belfast, Northern Ireland
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4
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Nakagawa NK, Lockey A, Carmona MJC, Hoover A, Nanda P, Böttiger BW. It is time to spread the message of high-quality layperson cardiopulmonary resuscitation all over the world. Clinics (Sao Paulo) 2024; 79:100355. [PMID: 38678872 PMCID: PMC11066593 DOI: 10.1016/j.clinsp.2024.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Naomi Kondo Nakagawa
- Education, Assessment and Intervention in Cardiovascular Group, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Andrew Lockey
- Calderdale and Huddersfield NHS Trust, Halifax, United Kingdom
| | - Maria José Carvalho Carmona
- Divisão de Anestesia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Amber Hoover
- American Heart Association, Texas, United States of America
| | - Prama Nanda
- European Resuscitation Council, Antwerp, Belgium
| | - Bernd Walter Böttiger
- Department of Anesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
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Oermann MH, VanRiel YM, Stieve DE, Vermeesch CA, Crane PC, Kratovil A, Baker M, Guerra DS, Chamness J, Saeed BA, Rogers V, Flicker JM, Patterson CM. Developing competency of nursing students in cardiopulmonary resuscitation using Resuscitation Quality Improvement technology. Int J Nurs Educ Scholarsh 2024; 21:ijnes-2023-0122. [PMID: 38680068 DOI: 10.1515/ijnes-2023-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES This study examined the outcomes of training nursing students in CPR skills using the Resuscitation Quality Improvement (RQI) program. METHODS Nursing students (n=2,193) in 12 schools across the United States participated in this study. Students performed compressions and bag-masked ventilation on adult and infant manikins using the RQI simulation station without and then with feedback on their performance. RESULTS With real-time, objective feedback from the RQI simulation station, students' performance of CPR skills improved, and they retained their skills over time. CONCLUSIONS The RQI program and methodology of feedback is effective for training nursing students to be competent in CPR skills, essential for safe patient care. Nursing and other healthcare professions programs should consider adopting the RQI program for students to develop competency in CPR.
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Affiliation(s)
| | - Yolanda M VanRiel
- Department of Nursing, North Carolina Central University, Durham, NC, USA
| | - Debra E Stieve
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Carol A Vermeesch
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Patrick C Crane
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Amanda Kratovil
- College of Nursing, Purdue University Northwest, Hammond, IN, USA
| | - Manisa Baker
- College of Nursing, Purdue University Northwest, Hammond, IN, USA
| | - Donna S Guerra
- College of Nursing, University of Alabama Huntsville, Huntsville, AL, USA
| | - Joseph Chamness
- College of Nursing, University of Alabama Huntsville, Huntsville, AL, USA
| | - Bushra Ahmad Saeed
- Division of Nursing, Allied Health, Life and Physical Sciences, University of the District of Columbia Community College, Washington DC, USA
| | - Vonda Rogers
- Division of Nursing, Allied Health, Life and Physical Sciences, University of the District of Columbia Community College, Washington DC, USA
| | - Joy M Flicker
- John and Karen Arnold School of Nursing, Alvernia University, Reading, PA, USA
| | - C Marie Patterson
- Physician Assistant Studies, Middle Tennessee State University, Murfreesboro, TN, USA
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6
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Liou FY, Lin KC, Chien CS, Hung WT, Lin YY, Yang YP, Lai WY, Lin TW, Kuo SH, Huang WC. The impact of bystander cardiopulmonary resuscitation on patients with out-of-hospital cardiac arrests. J Chin Med Assoc 2021; 84:1078-1083. [PMID: 34610624 DOI: 10.1097/jcma.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death around the world. Bystander cardiopulmonary resuscitation (CPR) is an independent factor to improve OHCA survival. However, the prevalence of bystander CPR remains low worldwide. Community interventions such as mandatory school CPR training or targeting CPR training to family members of high-risk cardiac patients are possible strategies to improve bystander CPR rate. Real-time feedback, hands-on practice with a manikin, and metronome assistance may increase the quality of CPR. Dispatcher-assistance and compression-only CPR for untrained bystanders have shown to increase bystander CPR rate and increase survival to hospital discharge. After return of spontaneous circulation, targeted temperature management should be performed to improve neurological function. This review focuses on the impact of bystander CPR on clinical outcomes and strategies to optimize the prevalence and quality of bystander CPR.
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Affiliation(s)
- Fang-Yu Liou
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chian-Shiu Chien
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ying Lin
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Yi Lai
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Wei Lin
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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7
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Hammer NC, Koch JJ, Hopkins HC. Neonatal Resuscitation: Updated Guidelines from the American Heart Association. Am Fam Physician 2021; 104:425-428. [PMID: 34652094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Noa C Hammer
- Naval Hospital Camp Pendleton Family Medicine Residency, Camp Pendleton, CA, USA
| | - John J Koch
- Naval Hospital Camp Pendleton Family Medicine Residency, Camp Pendleton, CA, USA
| | - Hilary C Hopkins
- Naval Hospital Camp Pendleton Family Medicine Residency, Camp Pendleton, CA, USA
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Higashino M, Hiraoka E, Kudo Y, Hoshina Y, Kitamura K, Sakai M, Ito S, Fujimoto Y, Hiasa Y, Hayashi K, Fujitani S, Suzuki T. Role of a rapid response system and code status discussion as determinants of prognosis for critical inpatients: An observational study in a Japanese urban hospital. Medicine (Baltimore) 2021; 100:e26856. [PMID: 34397894 PMCID: PMC8360430 DOI: 10.1097/md.0000000000026856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ± 13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.
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Affiliation(s)
- Makoto Higashino
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Eiji Hiraoka
- Department of General Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoshiko Kudo
- Intensive Care Unit, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yuiko Hoshina
- Strategic Planning and Analysis Division, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Koichi Kitamura
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Masahiro Sakai
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Shinsuke Ito
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoshihisa Fujimoto
- Department of Emergency and Critical Care Medicine, Division of Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koichi Hayashi
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toshihiko Suzuki
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
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Siebert JN, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Ehrler F, Manzano S. Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2123007. [PMID: 34459905 PMCID: PMC8406083 DOI: 10.1001/jamanetworkopen.2021.23007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking. OBJECTIVE To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. DESIGN, SETTING, AND PARTICIPANTS This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). INTERVENTION Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76). MAIN OUTCOMES AND MEASURES The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria. Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects. RESULTS In total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%]; mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P < .001), the mean time to drug preparation decreased by 40 seconds (95% CI, 23-57 seconds; P < .001), and the mean time to drug delivery decreased by 47 seconds (95% CI, 27-66 seconds; P < .001). The risk of medication errors varied across drugs with conventional methods (19.7%-100%) when compared with the app (4.1%-6.8%). CONCLUSIONS AND RELEVANCE Compared with conventional methods, the use of a mobile app significantly decreased the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting. Dedicated mobile apps have the potential to improve medication safety and change practices in pediatric emergency medicine. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03921346.
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Affiliation(s)
- Johan N. Siebert
- Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Christophe Combescure
- Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospital, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Suppan
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frédéric Ehrler
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children’s Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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10
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Lin CH, Yu SH, Chen CY, Huang FW, Chen WK, Shih HM. Early blood pH as an independent predictor of neurological outcome in patients with out-of-hospital cardiac arrest: A retrospective observational study. Medicine (Baltimore) 2021; 100:e25724. [PMID: 33907164 PMCID: PMC8084093 DOI: 10.1097/md.0000000000025724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Metabolic acidosis is observed in 98% of patients with out-of-hospital cardiac arrest (OHCA). The longer the no-flow or low-flow duration, the more severe is the acidosis in these patients. This study explored whether blood pH in early stages of advanced life support (ALS) was an independent predictor of neurological prognosis in patients with OHCA.We retrospectively enrolled patients with OHCA from January 2012 to June 2018 in a single-medical tertiary hospital in Taiwan. Patients with OHCA whose blood gas analyses within 5 minutes after receiving ALS at the emergency department (ED) were enrolled. Patients younger than 20 years old, with cardiac arrest resulting from traumatic or circumstantial causes, with return of spontaneous circulation (ROSC) before ED arrival, lacking record of initial blood gas analysis, and with do-not-resuscitate orders were excluded. The primary outcome of this study was neurological status at hospital discharge.In total, 2034 patients with OHCA were enrolled. The majority were male (61.89%), and the average age was 67.8 ± 17.0 years. Witnessed OHCA was noted in 571 cases, cardiopulmonary resuscitation was performed before paramedic arrival in 512 (25.2%) cases, and a shockable rhythm was observed in 269 (13.2%). Blood pH from initial blood gas analysis remained an independent predictor of neurological outcome after multivariate regression.Blood pH at early stages of ALS was an independent prognostic factor of post-OHCA neurological outcome. Blood gas analysis on arrival at the ED may provide additional information about the prognosis of patients with OHCA.
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Affiliation(s)
- Chin-Han Lin
- School of Medicine, College of Medicine, China Medical University
- Department of Emergency Medicine, China Medical University Hospital
| | - Shao-Hua Yu
- Department of Emergency Medicine, China Medical University Hospital
- Graduate Institute of Biomedical Sciences
| | - Chih-Yu Chen
- School of Medicine, College of Medicine, China Medical University
| | - Fen-Wei Huang
- Department of Emergency Medicine, China Medical University Hospital
| | - Wei-Kung Chen
- School of Medicine, College of Medicine, China Medical University
- Department of Emergency Medicine, China Medical University Hospital
| | - Hong-Mo Shih
- School of Medicine, College of Medicine, China Medical University
- Department of Emergency Medicine, China Medical University Hospital
- Department of Public Health, China Medical University, Taichung, Taiwan
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11
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Boivin-Proulx LA, Doherty A, Rousseau-Saine N, Doucet S, Ly HQ, Lavoie P, Thibodeau-Jarry N. Use of Simulation-Based Medical Education for Advanced Resuscitation of In-Hospital Cardiac Arrest Patients With Suspected or Confirmed COVID-19. Can J Cardiol 2021; 37:1267-1270. [PMID: 33775876 PMCID: PMC7997306 DOI: 10.1016/j.cjca.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiac arrest is common in critically ill patients with coronavirus disease 2019 (COVID-19) and is associated with poor survival. Simulation is frequently used to evaluate and train code teams with the goal of improving outcomes. All participants engaged in training on donning and doffing of personal protective equipment for suspected or confirmed COVID-19 cases. Thereafter, simulations of in-hospital cardiac arrest of patients with COVID-19, so-called protected code blue, were conducted at a quaternary academic centre. The primary endpoint was the mean time-to-defibrillation. A total of 114 patients participated in 33 “protected code blue” simulations over 8 weeks: 10 were senior residents, 17 were attending physicians, 86 were nurses, and 5 were respiratory therapists. Mean time-to-defibrillation was 4.38 minutes. Mean time-to-room entry, time-to-intubation, time-to-first-chest compression and time-to-epinephrine were 2.77, 5.74, 6.31, and 6.20 minutes, respectively; 92.84% of the 16 criteria evaluating the proper management of patients with COVID-19 and cardiac arrest were met. Mean time-to-defibrillation was longer than guidelines-expected time during protected code blue simulations. Although adherence to the modified advanced cardiovascular life-support protocol was high, breaches that carry additional infectious risk and reduce the efficacy of the resuscitation team were observed.
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Affiliation(s)
| | | | | | - Serge Doucet
- Montréal Heart Institute, Montréal, Québec, Canada
| | - Hung Q Ly
- Montréal Heart Institute, Montréal, Québec, Canada
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Lim WY, Ong J, Ong S, Teo L, Fook-Chong S, Ho V. Rapid degradation of psychomotor memory causes poor quality chest compressions in frequent cardiopulmonary resuscitation providers and feedback devices can only help to a limited degree: A crossover simulation study. Medicine (Baltimore) 2021; 100:e23927. [PMID: 33663043 PMCID: PMC7909212 DOI: 10.1097/md.0000000000023927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/27/2020] [Indexed: 01/05/2023] Open
Abstract
Studies report a decline in the psychomotor memory of cardiopulmonary resuscitation (CPR) providers within months of training, but they are prone to subject bias. We hypothesized that this degradation is faster and more prevalent in real world practice. The aims of our study were to 1. assess the quality of chest compressions (CC) delivered routinely by CPR-certified clinicians who are not primed by study conditions, and 2. investigate if psychomotor memory degrades if feedback devices are removed. Forty anaesthetists and intensivists participated in a voluntary, half-day, randomized crossover study using case-based simulation. Participants were paired and randomly assigned into 2 groups; each receiving automated feedback either in the first or second cycle of CPR. Two cycles of CC and defibrillation (ACLS protocol) were administered on a manikin. CC parameters including overall quality were measured by a feedback device. The median proportion of good quality CC was poor at baseline but improved with feedback; 38.2% (IQR 27.7, 58.7) to 57.7% (IQR 38.0, 68.7), P < .05. The median proportion of good quality CC fell after feedback withdrawal; 50.5% (IQR 24.5, 67.7) to 25.6% (9, 37.6), P < .05. No carryover effect was observed. Treatment effect and period effect were detected. Baseline quality of CC amongst frequent CPR providers is poor, and can be improved partly by feedback devices. As psychomotor memory of good quality CCs degrades rapidly after removal of feedback, a multimodal approach is required for CPR skill retention. Future research on the optimal frequency of CPR training, including the use of feedback devices in clinical practice should be explored.
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Affiliation(s)
- Wan Yen Lim
- Division of Anaesthesiology and Perioperative Sciences, Outram Road, Singapore General Hospital
- Department of Anesthesiology, Sengkang General Hospital
| | - John Ong
- Department of Medicine, National University of Singapore
| | - Sharon Ong
- Department of Anesthesiology, Sengkang General Hospital
- Division of Anaesthesiology and Perioperative Sciences, Outram Road, Singapore General Hospital, Singapore; Duke-NUS Medical School
| | - L.M. Teo
- Department of Anesthesiology, Sengkang General Hospital
- Division of Anaesthesiology and Perioperative Sciences, Outram Road, Singapore General Hospital, Singapore; Duke-NUS Medical School
| | - S. Fook-Chong
- Health Services Research Unit, Singapore General Hospital
| | - V.K. Ho
- Department of Anesthesiology, Sengkang General Hospital
- Division of Anaesthesiology and Perioperative Sciences and Intensive Care, Outram Road, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
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Jung H, Lee MJ, Cho JW, Lee SH, Lee SH, Mun YH, Chung HS, Kim YH, Kim GM, Park SY, Jeon JC, Kim C. External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era. Scand J Trauma Resusc Emerg Med 2021; 29:19. [PMID: 33504366 PMCID: PMC7838848 DOI: 10.1186/s13049-021-00834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/12/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era. METHODS This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18-March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. RESULTS In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval < 5%), specificity (100%), and PPV (> 99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. CONCLUSION Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.
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Affiliation(s)
- Haewon Jung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Jae Wan Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Sang Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Suk Hee Lee
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - You Ho Mun
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Han-sol Chung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Yang Hun Kim
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Gyun Moo Kim
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Sin-youl Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - on behalf of the WinCOVID-19 consortium
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
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Kim Y, Dym AA, Yang K, Fein DG, Bangar M, Ferenchick HRB, Keene A, Orsi D, Washington MA, Eisen LA. The Effect of Numbered Jerseys on Directed Commands, Teamwork, and Clinical Performance During Simulated Emergencies. J Healthc Qual 2021; 43:24-31. [PMID: 32502088 DOI: 10.1097/jhq.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Communication and teamwork are essential during inpatient emergencies such as cardiac arrest and rapid response (RR) codes. We investigated whether wearing numbered jerseys affect directed commands, teamwork, and performance during simulated codes. Eight teams of 6 residents participated in 64 simulations. Four teams were randomized to the experimental group wearing numbered jerseys, and four to the control group wearing work attire. The experimental group used more directed commands (49% vs. 31%, p < .001) and had higher teamwork score (25 vs. 18, p < .001) compared with control group. There was no difference in time to initiation of chest compression, bag-valve-mask ventilation, and correct medications. Time to defibrillation was longer in the experimental group (190 vs. 140 seconds, p = .035). Using numbered jerseys during simulations was associated with increased use of directed commands and better teamwork. Time to performance of clinical actions was similar except for longer time to defibrillation in the jersey group.
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Aziz K, Lee CHC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin J. Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2021; 147:peds.2020-038505E. [PMID: 33087555 DOI: 10.1542/peds.2020-038505e] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM. Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2021; 147:peds.2020-038505D. [PMID: 33087552 DOI: 10.1542/peds.2020-038505d] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wyckoff MH, Weiner CGM. 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics 2021; 147:peds.2020-038505C. [PMID: 33087553 DOI: 10.1542/peds.2020-038505c] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid.Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed.All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published.Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
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Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Bittencourt Couto T, Guerguerian AM, Nadkarni VM, Ng KC, Nuthall GA, Ong GYK, Reis AG, Schexnayder SM, Scholefield BR, Tijssen JA, Nolan JP, Morley PT, Van de Voorde P, Zaritsky AL, de Caen AR. Pediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics 2021; 147:peds.2020-038505B. [PMID: 33087557 DOI: 10.1542/peds.2020-038505b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation.Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.
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Picard C, Yang BG, Norris C, McIntosh S, Douma MJ. Cardiopulmonary Resuscitation Feedback: A Comparison of Device-Measured and Self-Assessed Chest Compression Quality. J Emerg Nurs 2020; 47:333-341.e1. [PMID: 33308832 DOI: 10.1016/j.jen.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-quality cardiopulmonary resuscitation is the foundation of cardiac arrest care. Guidelines specify chest compression depth, recoil, and rate, but providers often fail to achieve these targets. Furthermore, providers are largely unable assess the quality of their own or other peoples' chest compressions. Chest compression feedback devices can improve chest compression quality; their use is endorsed internationally, but they remain largely absent in clinical care. This article analyzes preclinical data collected during a quality improvement project. It describes provider demographics and perceptions about their chest compression quality and correlates them to measured chest compression quality, compares clinician perception of chest compressions to objective measures, and describes the effect of feedback on compression quality. METHODS Clinicians were recruited from 2 metropolitan emergency departments. A questionnaire was used to assess participants' levels of training and experience. A before-and-after assessment of chest compression quality was performed using a Laerdal CPRmeter 2 and a CPR mannequin. Pretest measures of chest compression quality were made by covering the device screen thereby blinding providers to feedback; repeat measures were then collected from the same participants but unblinded to feedback. Provider charecteristic were collected by survey. Correlations between blinded chest compression quality and provider charecteristics; the reliability of providers estimated compared to measured quality; and the effects of feedback on chest compression quality were assessed using Pearsons correlations, Cohens κ, and paired t testing. RESULTS 84 participants were assessed. The mean years of certification were 11.74. Ninty-five percent of the providers self-assessed as more experienced than novice and 81% reported performing cardiopulmonary resuscitation at least occasionally. The frequency of performing chest compressions was correlated with self-assessed skill (r = 0.58, P < .001). However, self-assessed skill was only weakly correlated with chest compression quality (r = 0.29, P = .01) and not at all with the frequency of performing chest compressions or years of certification. There was no agreement between self-assessed and device-measured chest compression depth (κ = -0.10, P = 0.11), recoil (κ = -0.14, P = .03), or rate (κ = 0.06, P =.30). The overall quality of compressions improved by 16.9%; the percentage of chest compressions achieving target depth by 3.58%; recoil by 22.82%; and rate by 23.66% with feedback. A total of 97.6% of the staff rated chest compression feedback helpful. CONCLUSIONS Our findings suggest that participants' demographics were not correlated with chest compression quality and that providers cannot reliably assess chest compression quality. The data also demonstrate that with minimal training, feedback can significantly improve chest compression quality.
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Vo AT, Cho CS. Neonatal resuscitation in the emergency department. Pediatr Emerg Med Pract 2020; 17:1-16. [PMID: 33211444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Although most neonates will not require resuscitation, emergency clinicians must be prepared to manage neonates who require respiratory assistance. This issue reviews current expert recommendations and consensus updates of the best practices in resuscitation of neonates. An overview of neonatal physiology provides a framework for understanding how neonatal resuscitation differs from that of children and adults. A step-wise, systematic approach is provided for identifying and managing newborns who require resuscitation. The treatment, management, and over-arching goals for neonatal resuscitation and newborn care are also reviewed.
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Affiliation(s)
- Andrea T Vo
- Pediatric Emergency Staff Physician, The Hospital for Sick Children, Toronto, Canada
| | - Christine S Cho
- Associate Professor of Clinical Pediatrics, Keck Medicine of USC; Fellowship and Education Director, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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Jaskiewicz F, Kowalewski D, Starosta K, Cierniak M, Timler D. Chest compressions quality during sudden cardiac arrest scenario performed in virtual reality: A crossover study in a training environment. Medicine (Baltimore) 2020; 99:e23374. [PMID: 33235109 PMCID: PMC7710239 DOI: 10.1097/md.0000000000023374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Potential attributes of virtual reality (VR) can be a breakthrough in the improvement of sudden cardiac arrest (SCA) training. However, interference with the virtual world is associated with the need of placing additional equipment on the trainee's body. The primary aim of the study was to evaluate if it does not affect the quality of chest compressions (CCs).91 voluntarily included in the study medical students participated twice in the scenario of SCA - Traditional Scenario (TS) and Virtual Reality Scenario (VRS). In both cases two minutes of resuscitation was performed.If VRS was the first scenario there were significant differences in CCs depth (VRS - Me = 47 mm [IQR 43 - 52] vs TS - Me = 48 mm [IQR 43 - 55]; P = .02) and chest relaxation (VRS - Me = 37% [IQR 5 - 91] vs TS - Me = 97% [IQR 87 - 100]; P < .001). 97.8% of respondents believe that training with the use of VR is more effective than a traditional method (P < .01). Most of the study group (91%, P < .01) denied any negative symptoms during the VR scenario.Virtual reality can be a safe and highly valued by medical students, method of hands-on CPR training. However additional VR equipment placed on the trainee's body may cause chest compressions harder to provide. If it is not preceded by traditional training, the use of VR may have an adverse impact on depth and full chest relaxation during the training. To make the best use of all the potential that virtual reality offers, future studies should focus on finding the most effective way to combine VR with traditional skill training in CPR courses curriculum.
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Serin S, Caglar B. The Effect of Different Personal Protective Equipment Masks on Health Care Workers' Cardiopulmonary Resuscitation Performance During the Covid-19 Pandemic. J Emerg Med 2020; 60:292-298. [PMID: 33303273 PMCID: PMC7640886 DOI: 10.1016/j.jemermed.2020.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022]
Abstract
Background Personal protective equipment (PPE) is equipment that protects health care workers from harmful agents and organisms. The importance of this equipment was noticed again with the Coronavirus Disease 2019 (COVID-19) pandemic. Objectives In this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue. Methods Participants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. They were requested to rate their fatigue on a visual analogue scale. Results Statistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compressions per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants. Conclusion Protective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.
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Affiliation(s)
- Suha Serin
- Department of Emergency Medicine, Balikesir University, Balikesir, Turkey
| | - Bahadir Caglar
- Department of Emergency Medicine, Balikesir University, Balikesir, Turkey
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Mavraganis G, Aivalioti E, Chatzidou S, Patras R, Paraskevaidis I, Kanakakis I, Stamatelopoulos K, Dimopoulos MA. Cardiac arrest and drug-related cardiac toxicity in the Covid-19 era. Epidemiology, pathophysiology and management. Food Chem Toxicol 2020; 145:111742. [PMID: 32916218 PMCID: PMC7833119 DOI: 10.1016/j.fct.2020.111742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 (Covid-19) infection has recently become a worldwide challenge with dramatic global economic and health consequences. As the pandemic is still spreading, new data concerning Covid-19 complications and related mechanisms become increasingly available. Accumulating data suggest that the incidence of cardiac arrest and its outcome are adversely affected during the Covid-19 period. This may be further exacerbated by drug-related cardiac toxicity of Covid-19 treatment regimens. Elucidating the underlying mechanisms that lead to Covid-19 associated cardiac arrest is imperative, not only in order to improve its effective management but also to maximize preventive measures. Herein we discuss available epidemiological data on cardiac arrest during the Covid-19 pandemic as well as possible associated causes and pathophysiological mechanisms and highlight gaps in evidence warranting further investigation. The risk of transmission during cardiopulmonary resuscitation (CPR) is also discussed in this review. Finally, we summarize currently recommended guidelines on CPR for Covid-19 patients including CPR in patients with cardiac arrest due to suspected drug-related cardiac toxicity in an effort to underscore the most important common points and discuss discrepancies proposed by established international societies.
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Affiliation(s)
- Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatzidou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Paraskevaidis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Kache S, Chisti MJ, Gumbo F, Mupere E, Zhi X, Nallasamy K, Nakagawa S, Lee JH, Di Nardo M, de la Oliva P, Katyal C, Anand KJS, de Souza DC, Lanziotti VS, Carcillo J. COVID-19 PICU guidelines: for high- and limited-resource settings. Pediatr Res 2020; 88:705-716. [PMID: 32634818 PMCID: PMC7577838 DOI: 10.1038/s41390-020-1053-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU. METHODS An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines. RESULTS This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described. CONCLUSION Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world. IMPACT At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.
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Affiliation(s)
- Saraswati Kache
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Mohammod Jobayer Chisti
- Intensive Care Unit and Clinical Research, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Felicity Gumbo
- Department of Pediatrics and Child Health, College of Health Sciences University of Zimbabwe, Harare, Zimbabwe
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Xia Zhi
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan City, Hubei Province, China
| | - Karthi Nallasamy
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health & Development, Tokyo, Japan
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore, Singapore
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - Pedro de la Oliva
- Pediatric Intensive Care Department, Hospital Universitario La Paz, Department of Pediatrics Medical School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Chhavi Katyal
- Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kanwaljeet J S Anand
- Department of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniela Carla de Souza
- Pediatric Intensive Care Unit, University of São Paulo & Hospital Sírio Libanês-, São Paulo, Brazil
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Joseph Carcillo
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kim SY, Shin D, Kim HJ, Karm MH. Changes of knowledge and practical skills before and after retraining for basic life support: Focused on students of Dental School. Int J Med Sci 2020; 17:3082-3090. [PMID: 33173429 PMCID: PMC7646099 DOI: 10.7150/ijms.47343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/07/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Considering the increasing possibility of emergency situations in dental clinics over time, we conducted this study to evaluate the changes in the knowledge and practical skills of students of dental school before and after retraining for 2 years after the initial education on basic life support (BLS) of the American Heart Association (AHA). Methods: All third-year students of dental school who had received the same education on BLS provider training of the AHA 2 years earlier were included in this study. Among them, 98 students were asked to answer a questionnaire about BLS knowledge and conduct a practical skills assessment of high-quality cardiopulmonary resuscitation using Little Anne QCPR before and after retraining. Results: After retraining, the level of BLS knowledge increased in all 7 categories, and BLS performance increased in all 19 subcategories. Comparison of the QCPR numerical data items before and after retraining showed that all items after retraining met the criteria recommended by the AHA. Conclusion: Students of dental school had low levels of knowledge and practical skills of BLS before retraining after 2 years from the initial education and had high levels after retraining. Therefore, BLS training must be updated periodically, and more effective education methods are required to maintain BLS knowledge and practical skills.
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Affiliation(s)
- Seo-Yoon Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Dongmin Shin
- Department of Emergency Medical Service, Korea National University of Transportation, Chungcheongbuk-do, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
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Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S469-S523. [PMID: 33081526 DOI: 10.1161/cir.0000000000000901] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wyckoff MH, Wyllie J, Aziz K, de Almeida MF, Fabres J, Fawke J, Guinsburg R, Hosono S, Isayama T, Kapadia VS, Kim HS, Liley HG, McKinlay CJD, Mildenhall L, Perlman JM, Rabi Y, Roehr CC, Schmölzer GM, Szyld E, Trevisanuto D, Velaphi S, Weiner GM. Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S185-S221. [PMID: 33084392 DOI: 10.1161/cir.0000000000000895] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid. Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed. All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published. Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian AM, Nadkarni VM, Ng KC, Nuthall GA, Ong GYK, Reis AG, Schexnayder SM, Scholefield BR, Tijssen JA, Nolan JP, Morley PT, Van de Voorde P, Zaritsky AL, de Caen AR. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S140-S184. [PMID: 33084393 DOI: 10.1161/cir.0000000000000894] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.
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Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S2-S27. [PMID: 33084397 DOI: 10.1161/cir.0000000000000890] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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Abraldes JA, Fernandes RJ, Rodríguez N, Sousa A. Is Rescuer Cardiopulmonary Resuscitation Jeopardised by Previous Fatiguing Exercise? Int J Environ Res Public Health 2020; 17:E6668. [PMID: 32933179 PMCID: PMC7559729 DOI: 10.3390/ijerph17186668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/02/2022]
Abstract
Survival outcomes increase significantly when cardiopulmonary resuscitation (CPR) is provided correctly, but rescuer's fatigue can compromise CPR delivery. We investigated the effect of a 100-m maximal run on CPR and physiological variables in 14 emergency medical technicians (age 29.2 ± 5.8 years, height 171.2 ± 1.1 cm and weight 73.4 ± 13.1 kg). Using an adult manikin and a compression-ventilation ratio of 30:2, participants performed 4-min CPR after 4-min baseline conditions (CPR) and 4-min CPR after a 100-m maximal run carrying emergency material (CPR-run). Physiological variables were continuously measured during baseline and CPR conditions using a portable gas analyzer (K4b2, Cosmed, Rome, Italy) and analyzed using two HD video cameras (Sony, HDR PJ30VE, Japan). Higher VO2 (14.4 ± 2.1 and 22.0 ± 2.5 mL·kg-1·min-1) and heart rate (123 ± 17 and 148 ± 17 bpm) were found for CPR-run. However, the compression rate was also higher during the CPR-run (373 ± 51 vs. 340 ± 49) and between every three complete cycles (81 ± 9 vs. 74 ± 14, 99 ± 14 vs. 90 ± 10, 99 ± 10 vs. 90 ± 10, and, 101 ± 15 vs. 94 ± 11, for cycle 3, 6, 9 and 12, respectively). Fatigue induced by the 100-m maximal run had a strong impact on physiological variables, but a mild impact on CPR emergency medical technicians' performance.
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Affiliation(s)
- J Arturo Abraldes
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, 30720 Murcia, Spain
- Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal
| | - Ricardo J Fernandes
- Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Núria Rodríguez
- Department of Physical Activity and Sport, Catholic University of San Antonio, 30107 Murcia, Spain
| | - Ana Sousa
- Research Center for Sports, Exercise and Human Development, 5001-801 Vila Real, Portugal
- University Institute of Maia, 4475-690 Maia, Portugal
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Real de Asúa D, Galván JM, Iglesias J, Fernández J. [Triage criteria for cardiopulmonary resuscitation and advanced life support during the COVID-19 epidemic]. Med Clin (Barc) 2020; 155:215-219. [PMID: 32466974 PMCID: PMC7205666 DOI: 10.1016/j.medcli.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Diego Real de Asúa
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España; Comité de Ética Asistencial, Hospital Universitario de La Princesa, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna, España.
| | - Jose María Galván
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España; Comité de Ética Asistencial, Hospital Universitario de La Princesa, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna, España
| | - Judit Iglesias
- Comité de Ética Asistencial, Hospital Universitario de La Princesa, Madrid, España; Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, España
| | - Julia Fernández
- Comité de Ética Asistencial, Hospital Universitario de La Princesa, Madrid, España; Unidad de Cuidados Paliativos, Hospital Universitario de La Princesa, Madrid, España
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Abstract
In light of the COVID-19 pandemic and uncertainties around risk of transmission, urgent hospital resuscitation (also known as "Code Blue") efforts are needed, pivoting to protect health care workers. This article provides teaching tips for "Protected Code Blues." [J Contin Educ Nurs. 2020;51(9):399-401.].
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Chelladurai G, Noor Azhar AM, Mohd Isa R, Bustam A, Ahmad R, Munisamy M. Improving cardiopulmonary resuscitation (CPR) performance using an audio-visual feedback device for healthcare providers in an emergency department setting in Malaysia: a quasi-experimental study. Med J Malaysia 2020; 75:514-518. [PMID: 32918419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers. METHODS This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models. RESULTS The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44). CONCLUSION The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.
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Affiliation(s)
| | - A M Noor Azhar
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | | | - A Bustam
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | - R Ahmad
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | - M Munisamy
- Chulalongkorn University, College of Public Health Sciences, Bangkok, Thailand.
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Gravesteijn BY, Schluep M, Disli M, Garkhail P, Dos Reis Miranda D, Stolker RJ, Endeman H, Hoeks SE. Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis. Crit Care 2020; 24:505. [PMID: 32807207 PMCID: PMC7430015 DOI: 10.1186/s13054-020-03201-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR), is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. METHODS We performed a comprehensive systematic search of all studies up to December 20, 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. RESULTS Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI 28-33%, I2 = 0%, p = 0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI 80-88%, I2 = 24%, p = 0.90). CONCLUSION ECPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.
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Affiliation(s)
- Benjamin Yaël Gravesteijn
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Marc Schluep
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Intensive Care, OLVG, Amsterdam, The Netherlands
| | - Maksud Disli
- Erasmus University Medical Centre School of Medicine, Rotterdam, The Netherlands
| | - Prakriti Garkhail
- Erasmus University Medical Centre School of Medicine, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Robert-Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sanne Elisabeth Hoeks
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Affiliation(s)
- Daniel B Kramer
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School - both in Boston (D.B.K.); the Greenwall Foundation, New York (B.L.); the University of California, San Francisco, San Francisco (B.L.); and Emory University School of Medicine, Atlanta (N.W.D.)
| | - Bernard Lo
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School - both in Boston (D.B.K.); the Greenwall Foundation, New York (B.L.); the University of California, San Francisco, San Francisco (B.L.); and Emory University School of Medicine, Atlanta (N.W.D.)
| | - Neal W Dickert
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School - both in Boston (D.B.K.); the Greenwall Foundation, New York (B.L.); the University of California, San Francisco, San Francisco (B.L.); and Emory University School of Medicine, Atlanta (N.W.D.)
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Gu XM, Yao SB, He ZJ, Wang YG, Li ZH. Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China. Mil Med Res 2020; 7:34. [PMID: 32631439 PMCID: PMC7339510 DOI: 10.1186/s40779-020-00263-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic evaluation of the successful heartbeat recovery rate (HRR) in patients during the platinum ten minutes after cardiac arrest. METHODS The databases of CNKI (January 1979-March 2019), Chongqing VIP (January 1989-March 2019), Wanfang (January 1990-March 2019) and Web of Science (1900-May 2020) were searched. To collect the clinical data of patients with cardiac arrest before hospitalization and analyze the cardiopulmonary resuscitation (CPR) at different times. Literature selection and data extraction were carried out by two researchers independently, and the meta package of R software (version 3. 61) was used for analysis. RESULTS A total of 116 papers met the inclusion criteria, including 37,181 patients. Of these patients, 3367 had their heartbeats successfully restored. The results showed a high degree of heterogeneity (χ2 = 6999.21, P < 0.01, I2 = 97.6%). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.199 (0.157-0.250). (1) According to the five CPR groups (International Cardiopulmonary Resuscitation Guide 2000, 2005, 2010, 2015 and other versions), the HRR of other versions [0.264 (0.176-0.375)] was higher than the International Cardiopulmonary Resuscitation 2005 edition [0.121 (0.092-0.158)]. (2) The rescue time was divided into the 0 to ≤5 min group, the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. The HRR were 0.417 (0.341-0.496), 0.143 (0.104-0.193), 0.049 (0.034-0.069), and 0.022 (0.009-0.051), respectively. The HRR was higher in the 0 to ≤5 min group than in the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. There was no difference between the 10 to ≤15 min group and the > 15 min group. (3) When the groups were stratified with the cutoff of 10 min, the ≤10 min group HRR [0.250 (0.202-0.306)] was higher than the > 10 min group rate [0.041 (0.029-0.057)]. (4) The HRR of the telephone guidance group was [0.273 (0.227-0.325)] lower than that of the 0 to ≤5 min group [0.429 (0.347-0.516)] but higher than that of the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. (5) The HRR of the witness group [0.325 (0.216-0.458)] was not different from that of the 0 to ≤5 min group, but it was higher than those of the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. (6) There was no significant difference HRR between the witnessed group, the telephone guidance group and the ≤10 min group. CONCLUSIONS (1) The HRR is time-sensitive, and early rescue can improve it. (2) CPR performed within the platinum ten minutes must be executed by the public, and other forces are auxiliary. (3) The concept of peri-cardiac arrest period (PCAP) should be established and improved to guide CPR.
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Affiliation(s)
- Xiang-Min Gu
- Tianjin Binhai New Area Center for Disease Control and Prevention, Tianjin, 300450, China
| | - Shi-Bin Yao
- Emergency Department, Affiliated Hospital of Chifeng College, Chifeng, 024005, Inner Mongolia, China
| | - Zhong-Jie He
- The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
| | - Yong-Gang Wang
- Beijing Platinum Ten Minutes Time-effect Emergency Technology Research Academy, Beijing, 100039, China
| | - Zhi-Hui Li
- Beijing Chaoyang District Jiangtai Community Health Service Center, Beijing, 100016, China
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Hautz SC, Oberholzer DL, Freytag J, Exadaktylos A, Kämmer JE, Sauter TC, Hautz WE. An observational study of self-monitoring in ad hoc health care teams. BMC Med Educ 2020; 20:201. [PMID: 32576185 PMCID: PMC7313223 DOI: 10.1186/s12909-020-02115-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. METHODS We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. RESULTS 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. CONCLUSION Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.
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Affiliation(s)
- Stefanie C Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Daniel L Oberholzer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Julia Freytag
- Simulated Patient Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Max Planck Institute for Human Development, Center for Adaptive Rationality (ARC), Lentzeallee 94, 14195, Berlin, Germany
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Lernzentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland.
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Guimarães HP, Timerman S, Rodrigues RDR, Corrêa TD, Schubert DUC, Freitas AP, Rea Neto Á, Polastri TF, Vane MF, Couto TB, Brandão ACA, Giannetti NS, Timerman T, Hajjar LA, Bacal F, Lopes MACQ. Position Statement: Cardiopulmonary Resuscitation of Patients with Confirmed or Suspected COVID-19 - 2020. Arq Bras Cardiol 2020; 114:1078-1087. [PMID: 32638902 PMCID: PMC8416124 DOI: 10.36660/abc.20200548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.
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Affiliation(s)
| | - Sérgio Timerman
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Matheus Fachini Vane
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | - Fernando Bacal
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Yang M, Dong H, Lu Z. Role of anaesthesiologists during the COVID-19 outbreak in China. Br J Anaesth 2020; 124:666-669. [PMID: 32307116 PMCID: PMC7144667 DOI: 10.1016/j.bja.2020.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Manping Yang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Hailong Dong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China
| | - Zhihong Lu
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, China.
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Donoghue AJ, Kou M, Good GL, Eiger C, Nash M, Henretig FM, Stacks H, Kochman A, Debski J, Chen JY, Sharma G, Hornik CP, Gosnell L, Siegel D, Krug S, Adler MD. Impact of Personal Protective Equipment on Pediatric Cardiopulmonary Resuscitation Performance: A Controlled Trial. Pediatr Emerg Care 2020; 36:267-273. [PMID: 32483079 PMCID: PMC7274141 DOI: 10.1097/pec.0000000000002109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to determine whether personal protective equipment (PPE) results in deterioration in chest compression (CC) quality and greater fatigue for administering health care providers (HCPs). METHODS In this multicenter study, HCPs completed 2 sessions. In session 1 (baseline), HCPs wore normal attire; in session 2, HCPs donned full PPE. During each session, they performed 5 minutes of uninterrupted CCs on a child manikin. Chest compression rate, depth, and release velocity were reported in ten 30-second epochs. Change in CC parameters and self-reported fatigue were measured between the start and 2- and 5-minute epochs. RESULTS We enrolled 108 HCPs (prehospital and in-hospital providers). The median CC rate did not change significantly between epochs 1 and 10 during baseline sessions. Median CC depth and release velocity decreased for 5 minutes with PPE. There were no significant differences in CC parameters between baseline and PPE sessions in any provider group. Median fatigue scores during baseline sessions were 2 (at start), 4 (at 2 minutes), and 6 (at 5 minutes). There was a significantly higher median fatigue score between 0 and 5 minutes in both study sessions and in all groups. Fatigue scores were significantly higher for providers wearing PPE compared with baseline specifically among prehospital providers. CONCLUSIONS During a clinically appropriate 2-minute period, neither CC quality nor self-reported fatigue worsened to a significant degree in providers wearing PPE. Our data suggest that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use.
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Affiliation(s)
- Aaron J Donoghue
- From the Departments of Anesthesia and Critical Care Medicine
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maybelle Kou
- Department of Emergency Medicine
- Inova Center for Advanced Medical Simulation, Inova Fairfax Medical Campus, Falls Church, VA
| | | | - Carmel Eiger
- Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mark Nash
- Fairfax County Fire and Rescue Department, Hazardous Materials Response Team, Fairfax, VA
| | - Fred M Henretig
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Helen Stacks
- Inova Center for Advanced Medical Simulation, Inova Fairfax Medical Campus, Falls Church, VA
| | | | | | | | | | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Leigh Gosnell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - David Siegel
- Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Steven Krug
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mark D Adler
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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Rodríguez Yago MA, Alcalde Mayayo I, Gómez López R, Parias Ángel MN, Pérez Miranda A, Canals Aracil M, Civantos Fuentes E, Rodríguez Núñez A, Manrique Martínez I, López-Herce Cid J, Zeballos Sarrato G, Calvo Macías C, Hernández-Tejedor A. [Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. Med Intensiva 2020; 44:566-576. [PMID: 32425289 PMCID: PMC7229968 DOI: 10.1016/j.medin.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en 5 partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas.
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Affiliation(s)
- M A Rodríguez Yago
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, España.
| | - I Alcalde Mayayo
- Servicio de Medicina Intensiva, Hospital QuirónSalud Palma Planas, Palma, España
| | - R Gómez López
- Servicio de Medicina Intensiva, Hospital QuirónSalud Miguel Domínguez, Pontevedra, España
| | - M N Parias Ángel
- Servicio de Medicina Intensiva, Hospital Santa Bárbara, Puertollano, España
| | - A Pérez Miranda
- Servicio de Urgencias, Hospital Nuestra Señora de los Reyes, Valverde, El Hierro, España
| | | | | | - A Rodríguez Núñez
- Unidad de Cuidados Intensivos Pediátricos, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - I Manrique Martínez
- Presidente del GERCPyN. Instituto Valenciano de Pediatría y Puericultura, Valencia, España
| | - J López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - G Zeballos Sarrato
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Calvo Macías
- Coordinador del Grupo de Trabajo de RCP Pediátrica y Neonatal del CERP, Málaga, España
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Leonardsen ACL, Svendsen EJ, Heitmann GB, Dhayyat A, Morris A, Sjøborg KD, Olsen RM, Hardeland C. Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy. PLoS One 2020; 15:e0232984. [PMID: 32396569 PMCID: PMC7217426 DOI: 10.1371/journal.pone.0232984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancy. METHODS The study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire. RESULTS The expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach's alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts' test of sphericity was greater than the critical value for chi-square, and significant (p < .0001). CONCLUSIONS Findings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.
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Affiliation(s)
- Ann-Chatrin L. Leonardsen
- Department of Health and Welfare, Ostfold University College, Halden, Norway
- Department of Anesthesiology, Ostfold Hospital Trust, Grålum, Norway
| | - Edel J. Svendsen
- Department of Health and Society, University of Oslo, Oslo, Norway
| | | | - Adam Dhayyat
- Department of Medicine, Ostfold Hospital Trust, Grålum, Norway
| | - Ann Morris
- Department of Obstetrics and Gynecology, Ostfold Hospital Trust, Grålum, Norway
| | - Katrine D. Sjøborg
- Department of Obstetrics and Gynecology, Ostfold Hospital Trust, Grålum, Norway
| | - Richard M. Olsen
- Department of Competence Development, Ostfold Hospital Trust, Grålum, Norway
| | - Camilla Hardeland
- Department of Health and Welfare, Ostfold University College, Halden, Norway
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Costa IBSDS, Bittar CS, Rizk SI, de Araújo AE, Santos KAQ, Machado TIV, Andrade FTDA, González TB, Arévalo ANG, de Almeida JP, Bacal F, de Oliveira GMM, de Lacerda MVG, Barberato SH, Chagas ACP, Rochitte CE, Ramires JAF, Kalil R, Hajjar LA. The Heart and COVID-19: What Cardiologists Need to Know. Arq Bras Cardiol 2020; 114:805-816. [PMID: 32401847 PMCID: PMC8386992 DOI: 10.36660/abc.20200279] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.
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Affiliation(s)
- Isabela Bispo Santos da Silva Costa
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Cristina Salvadori Bittar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Stephanie Itala Rizk
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Antônio Everaldo de Araújo
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Karen Alcântara Queiroz Santos
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Theuran Inahja Vicente Machado
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Fernanda Thereza de Almeida Andrade
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Thalita Barbosa González
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Andrea Nataly Galarza Arévalo
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Juliano Pinheiro de Almeida
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Fernando Bacal
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Gláucia Maria Moraes de Oliveira
- Universidade Federal do Rio de JaneiroRio de JaneirRJBrasilUniversidade Federal do Rio de Janeiro – Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcus Vinícius Guimarães de Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrasilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM - Brasil
| | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico CardiovascularCuritibaPRBrasilCardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico CuritibaPRBrasilQuanta Diagnóstico – Ecocardiografia, Curitiba, PR - Brasil
| | - Antonio Carlos Palandri Chagas
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
- Faculdade de MedicinaFundação do ABCSanto AndréSPBrasilFaculdade de Medicina da Fundação do ABC, Santo André, SP - Brasil
| | - Carlos Eduardo Rochitte
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração, São Paulo, SP – Brasil
| | - José Antonio Franchini Ramires
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Roberto Kalil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Ludhmila Abrahão Hajjar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasilUniversidade de São Paulo - Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
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Affiliation(s)
- Francesco P Cappuccio
- University of Warwick and University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV4 7AL, UK
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48
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Fuller C. DNACPR: don't leave it until too late to talk. Br J Community Nurs 2020; 25:109. [PMID: 32160024 DOI: 10.12968/bjcn.2020.25.3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Clare Fuller
- Lead Practitioner, Palliative and End of Life Care, Kent Community Health NHS Foundation Trust; Care Quality Commission Specialist Advisor
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Boudiche S, Zelfani S, Ben Hammamia M, Mghaieth Zghal F, Ouaghlani K, Ben Halima M, Manai H, Ziadi J, Rekik B, Rajhi M, Gharsallaoui O, Farhati A, Ouali S, Larbi N, Denguir R, Daghfous M, Mourali MS. Simulation training for continuing professional development of nurses in cardiology and cardiovascular surgery. Tunis Med 2020; 98:116-122. [PMID: 32395800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nurses play a key role in cardiac arrest management, especially those assigned to cardiac intensive care units, where they are often actively involved in cardiopulmonary resuscitation. AIM To evaluate the effect of simulation training in in continuing professional development of nurses in this setting. METHODS A comparative study using paired samples (where the candidate was his own control with repeated measures before and after intervention), was conducted among nurses working in the cardiology and cardiovascular surgery division of our institution. The primary endpoint was the change in skills judged on the basis of competency score of 20 assessed before and after simulation training. RESULTS 32 nurses participated in the training session. Despite a median job seniority of 8.5 years [4.0 - 12.5], only 44% of nurses had already participated in a simulation session. Although most of the candidates (84%) had previously performed chest compressions, only 34% had delivered an electrical defibrillation during their exercise. We showed a significant increase in overall scores from 8.0 [5.0 - 9.8] to 17.5 [17.0 - 19.0] after the simulation training session (p<0.0001). All the criteria judged in the evaluation grid (basic life support, manual electrical defibrillation) were significantly improved and the most positive effect was observed in the manual defibrillation where the prior experience of the participants was limited. CONCLUSIONS Simulation learning had a major positive impact on the development of nurses' skills in terms of cardiopulmonary resuscitation.
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Abstract
Hypothermic cardiac arrest is rare and poses a challenge to prehospital responders. Standard cardiac arrest protocols advise treating reversible causes of arrest; however, rewarming the cold casualty is not easily achieved in the field. This article aimed to review the literature on hypothermia in order to produce evidence-based recommendations on rewarming that could realistically be applied to hypothermic cardiac arrest patients.
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Affiliation(s)
- Robert Willmore
- Institute of Pre-Hospital Care at London's Air Ambulance, The Royal London Hospital, London, United Kingdom.
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