Active Cardiopulmonary Resuscitation Research Articles

Effectiveness of virtual and augmented reality for cardiopulmonary resuscitation training: a systematic review and meta-analysis

BackgroundVirtual reality (VR) and augmented reality (AR) are emerging technologies that can be used for cardiopulmonary resuscitation (CPR) training. Compared to traditional face-to-face training, VR/AR-based training has the potential to reach a wider audience, but there is debate regarding its effectiveness in improving CPR quality. Therefore, we conducted a meta-analysis to assess the effectiveness of VR/AR training compared with face-to-face training.MethodsWe searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang databases from the inception of these databases up until December 1, 2023, for randomized controlled trials (RCTs) comparing VR- and AR-based CPR training to traditional face-to-face training. Cochrane's tool for assessing bias in RCTs was used to assess the methodological quality of the included studies. We pooled the data using a random-effects model with Review Manager 5.4, and assessed publication bias with Stata 11.0.ResultsNine RCTs (involving 855 participants) were included, of which three were of low risk of bias. Meta-analyses showed no significant differences between VR/AR-based CPR training and face-to-face CPR training in terms of chest compression depth (mean difference [MD], -0.66 mm; 95% confidence interval [CI], -6.34 to 5.02 mm; P = 0.82), chest compression rate (MD, 3.60 compressions per minute; 95% CI, -1.21 to 8.41 compressions per minute; P = 0.14), overall CPR performance score (standardized mean difference, -0.05; 95% CI, -0.93 to 0.83; P = 0.91), as well as the proportion of participants meeting CPR depth criteria (risk ratio [RR], 0.79; 95% CI, 0.53 to 1.18; P = 0.26) and rate criteria (RR, 0.99; 95% CI, 0.72 to 1.35; P = 0.93). The Egger regression test showed no evidence of publication bias.ConclusionsOur study showed evidence that VR/AR-based training was as effective as traditional face-to-face CPR training. Nevertheless, there was substantial heterogeneity among the included studies, which reduced confidence in the findings. Future studies need to establish standardized VR/AR-based CPR training protocols, evaluate the cost-effectiveness of this approach, and assess its impact on actual CPR performance in real-life scenarios and patient outcomes.Trial registrationCRD42023482286.

Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children

For pediatric out-of-hospital cardiac arrest (OHCA), emergency medical services (EMS) may elect to transport to the hospital during active cardiopulmonary resuscitation (CPR) (ie, intra-arrest transport) or to continue on-scene CPR for the entirety of the resuscitative effort. The comparative effectiveness of these strategies is unclear. To evaluate the association between intra-arrest transport compared with continued on-scene CPR and survival after pediatric OHCA, and to determine whether this association differs based on the timing of intra-arrest transport. This cohort study included pediatric patients aged younger than 18 years with EMS-treated OHCA between December 1, 2005 and June 30, 2015. Data were collected from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective 10-site OHCA registry in the US and Canada. Data analysis was performed from May 2022 to February 2024. Intra-arrest transport, defined as an initiation of transport prior to the return of spontaneous circulation, and the interval between EMS arrival and intra-arrest transport. The primary outcome was survival to hospital discharge. Patients who underwent intra-arrest transport at any given minute after EMS arrival were compared with patients who were at risk of undergoing intra-arrest transport within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions. We examined subgroups based on age (<1 year vs ≥1 year). Of 2854 eligible pediatric patients (median [IQR] age, 1 [0-9] years); 1691 males [59.3%]) who experienced OHCA between December 2005 and June 2015, 1892 children (66.3%) were treated with intra-arrest transport and 962 children (33.7%) received continued on-scene CPR. The median (IQR) time between EMS arrival and intra-arrest transport was 15 (9-22) minutes. In the propensity score-matched cohort (3680 matched cases), there was no significant difference in survival to hospital discharge between the intra-arrest transport group and the continued on-scene CPR group (87 of 1840 patients [4.7%] vs 95 of 1840 patients [5.2%]; risk ratio [RR], 0.81 [95% CI, 0.59-1.10]). Survival to hospital discharge was not modified by the timing of intra-arrest transport (P value for the interaction between intra-arrest transport and time to matching = .10). Among patients aged younger than 1 year, intra-arrest transport was associated with lower survival to hospital discharge (RR, 0.52; 95% CI, 0.33-0.83) but there was no association for children aged 1 year or older (RR, 1.22; 95% CI, 0.77-1.93). In this cohort study of a North American OHCA registry, intra-arrest transport compared with continued on-scene CPR was not associated with survival to hospital discharge among children with OHCA. However, intra-arrest transport was associated with a lower likelihood of survival to hospital discharge among children aged younger than 1 year.

Finite Element Analysis of a Rib Cage Model: Influence of Four Variables on Fatigue Life during Simulated Manual CPR.

Cardiopulmonary resuscitation (CPR) is a life-saving technique used in emergencies when the heart stops beating, typically involving chest compressions and ventilation. Current adult CPR guidelines do not differentiate based on age beyond infancy and childhood. This oversight increases the risk of fatigue fractures in the elderly due to decreased bone density and changes in thoracic structure. Therefore, this study aimed to investigate the correlation and impact of factors influencing rib fatigue fractures for safer out-of-hospital manual cardiopulmonary resuscitation (OHMCPR) application. Using the finite element analysis (FEA) method, we performed fatigue analysis on rib cage models incorporating chest compression conditions and age-specific trabecular bone properties. Fatigue life analyses were conducted on three age-specific rib cage models, each differentiated by trabecular bone properties, to determine the influence of four explanatory variables (the properties of the trabecular bone (a surrogate for the age of the subject), the site of application of the compression force on the breastbone, the magnitude of applied compression force, and the rate of application of the compression force) on the fatigue life of the model. Additionally, considering the complex interaction of chest compression conditions during actual CPR, we aimed to predict rib fatigue fractures under conditions simulating real-life scenarios by analyzing the sensitivity and interrelation of chest compression conditions on the model's fatigue life. Time constraints led to the selection of optimal analysis conditions through the use of design of experiments (DOE), specifically orthogonal array testing, followed by the construction of a deep learning-based metamodel. The predicted fatigue life values of the rib cage model, obtained from the metamodel, showed the influence of the four explanatory variables on fatigue life. These results may be used to devise safer CPR guidelines, particularly for the elderly at a high risk of acute cardiac arrest, safeguarding against potential complications like fatigue fractures.

Comparison of the effects of using feedback devices for training or simulated cardiopulmonary arrest

BackgroundHigh-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC).MethodsWe use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5–6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100–120 cpm).ResultsThe use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device.ConclusionUsing a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

Abstract 181: Adiponectin Alleviates Acute Murine Pulmonary Injury Post Cardiopulmonary Resuscitation

Objective: Patients with cardiac arrest (CA) are often suffering from pulmonary ischemia-reperfusion injury after active cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC). In recent years, previous studies have found that acute lung injury (ALI) after ROSC could be an independent risk factor for the prognosis of out of hospital cardiac arrest (OHCA). However, there is still a lack of effective therapy for pulmonary injury caused by CA-CPR-ROSC with no side effects. Methods: C57BL/6 male mice, aged from 8 to 10 weeks were purchased from Dossy Experimental Animals Co. Ltd (Chengdu, China). All the mice were feeding and drinking freely in the animal room of Sichuan University West China Science and Technology Park for one week. The experiments involving mice were approved by the Ethics Committee from West China Hospital of Sichuan University (approval No.2017071A). At the day before experiment, mice were given fasting treatment but allowed to drink water freely. CA-CPR-ROSC could cause global cerebral ischemia injury in vivo. APN (10μg/0.05ml per mice) was intravenously injected to mice at 10 min after restoration of spontaneous circulation (ROSC). Computed tomography (CT) scan of the lungs was performed before executing the animals. We used the Opal Color Manual IHC staining Kit for multiplex immunofluorescence staining measurement. Western blot detected the expression of Nrf2, OCLN, and CLDN5 in murine pulmonary tissues. Results: The results of CT scanning and routine histological measurements showed that APN could protect mice against murine pulmonary injury caused by CA-CPR-ROSC, compared to that of mice in CA-CPR-ROSC group. The results of western blot suggested that the expression of Nrf2 significantly increased in mice pulmonary tissues in CA-CPR-ROSC, whereas the expression of OCLN and CLDN5 obviously decreased in murine pulmonary tissues in CA-CPR-ROSC. Conclusion: Current study indicated the protect role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC. The protective role of Adiponectin against acute murine pulmonary injury caused by CA-CPR-ROSC might be associated to the Nrf2 signaling pathway.

One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation.

The incidence of cardiogenic shock cases treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been on the rise. Acute kidney injury (AKI) is a significant complication of cardiogenic shock and a frequent serious complication in patients requiring ECMO-supported therapy. AKI is strongly associated with unfavorable patient prognosis. However, there is a paucity of data on the influence of AKI on the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) who are receiving ECMO support, particularly with regard to long-term outcomes. This retrospective observational study included 103 patients in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 and June 2022. AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Cox regression and logistic regression were used to identify risk factors. In this study, the incidence of AKI was 63.11%, with AKI stage 1, 2, and 3 accounting for 21.36%, 12.62%, and 29.13%, respectively. Patients with severe AKI had significantly higher in-hospital mortality (43.33% vs 27.40%, P < 0.001), 30-day mortality (60.00% vs 31.51%, P = 0.001), and 1-year mortality (63.67% vs 34.25%, P<0.001) than those without severe AKI. Furthermore, severe AKI significantly increased the risk of one-year mortality (HR 10.816, CI 3.118-37.512, P<0.001). Baseline serum creatinine, baseline platelet, and active cardiopulmonary resuscitation were independent predictors of one-year mortality. In addition, baseline white blood cell count, baseline aspartate aminotransferase, baseline alanine aminotransferase (ALT), baseline serum creatinine, preoperative lactate, and postoperative mean arterial pressure were independent risk factors of severe AKI during hospitalization. In patients with AMI-CS receiving ECMO support, AKI is highly prevalent. Development of severe AKI significantly increased the risk of one-year mortality.

Association of CPR simulation program characteristics with simulated and actual performance during paediatric in-hospital cardiac arrest

AimTo evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest. MethodsThis is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016–March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded. Actual CPR performance was recorded for children 37 weeks post-conceptual age to 18 years who received chest compressions of any duration, and included intra-arrest haemodynamics and CPR mechanics. Outcomes included survival to hospital discharge with favourable neurologic status. ResultsOverall, 18,912 point-of-care simulations were included. Simulation characteristics associated with both simulation and actual performance included site, participant discipline, and timing of simulation training. Simulation characteristics were not associated with survival with favourable neurologic outcome. However, participants in the top 3 sites for improvement in survival with favourable neurologic outcome were more likely to have participated in a simulation in the past month, on a weekday day, to be nurses, and to achieve targeted depth of compression and chest compression fraction goals during simulations than the bottom 3 sites. ConclusionsPoint-of-care simulation characteristics were associated with both simulated and actual CPR performance. More recent simulation, increased nursing participation, and simulation training during daytime hours may improve CPR performance.

Paediatric cardiopulmonary resuscitation quality during simulation of in-hospital transport

In-hospital cardiac arrests that occur outside of the intensive care unit may require transportation during active cardiopulmonary resuscitation. Studies have shown that high-quality cardiopulmonary resuscitation is imperative for survival with preserved neurologic function. We sought to determine if high-quality cardiopulmonary resuscitation is maintained during simulated transportation of paediatric in-hospital cardiac arrest. Randomized crossover simulated study of paediatric in-hospital cardiac arrest with 10 teams composed of five providers (physicians, advanced practice providers, nurses and respiratory therapists). Teams remained in a simulation room or transported the mannequin between two rooms. The primary analysis compared chest compression fraction in stationary versus transport simulations. Secondary analyses included additional cardiopulmonary resuscitation quality metrics with comparison to the 2015 American Heart Association standards. There was no significant difference in chest compression fraction or rate between the transport and stationary groups. 92%, 72% and 26% of epochs met American Heart Association criteria for compression fraction, rate and depth, respectively. Stationary simulations were more likely to meet recommendations for combined quality metrics, including compression fraction and rate (77 vs. 53; Chest compression fraction was preserved during simulated in-hospital cardiac arrest with transport. However, the transport simulation was less likely to meet American Heart Association recommendations for combined metrics. Similar to previous cardiopulmonary resuscitation quality studies, both teams failed to meet depth requirements in the majority of simulations.

The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis.

Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. PROSPERO: CRD42020205754.

Femoral Arterial Doppler Use During Active Cardiopulmonary Resuscitation.

This study explored femoral arterial Doppler during active cardiopulmonary resuscitation (CPR) to identify and characterize the resumptions of cardiac activity without stopping CPR. This was a proof-of-concept study exploring arterial Doppler during cardiac arrest. Patients in cardiac arrest undergoing active CPR were prospectively enrolled. Arterial Doppler of the common femoral artery was recorded during CPR and during pauses in CPR. CPR-induced arterial tracings and native cardiac-induced tracings were analyzed for rate and peak systolic velocity. Cardiac activity on echocardiogram during pause in CPR was classified as "absent," "disorganized," or "organized." Descriptive data and survival are presented as mean and 95% confidence intervals (CI), as well as sensitivity and specificity of Doppler during active CPR in detecting native cardiac pulsations. Sixteen patients with 48 paired Doppler recordings during active CPR, pause in CPR, and associated echocardiogram were enrolled. Native cardiac-induced tracings were visible during 39.6% of pauses in CPR (19 of 48) and during 18.8% of the periods of active CPR (9 of 48). Arterial pulsations were more frequently visualized with organized contractions by echocardiogram (10 of 14, 71%) than disorganized contractions (9 of 22, 41%). Arterial Doppler was 100% specific and 50% sensitive in detecting organized cardiac activity during active CPR. Patients with visible native cardiac pulsations during active CPR demonstrated 0% mortality compared with 67% mortality without visible arterial pulsations. Arterial Doppler tracings may identify the resumption of native cardiac activity during active CPR; however, more research is needed.

Direct versus Video Laryngoscopy during Simulated Mechanical Chest Compressions: A Randomized Crossover Trial.

Sir, Mechanical compression devices are often utilized for cardiopulmonary resuscitation (mCPR) in the emergency department (ED). We conducted an investigation to evaluate the time to intubation, operator confidence, and success rates of endotracheal intubation with video laryngoscopy (VL) versus direct laryngoscopy (DL) during simulated mCPR. This was a prospective, randomized crossover trial. Thirty consenting emergency physicians were surveyed about experience/technique preferences, and then performed intubations on a moderately difficult airway and adult Manikin during simulated mCPR (LUCAS 3.0) at 100 compressions/min. Technique order was randomized. Intubation time defined as blade pick up until the tube cuff inflated. Participants rated success confidence on a 5-point scale (high = 5) and provided the Cormack/Lehane grade (difficult = 3 or 4). The scenario was repeated with the alternate technique. The categorical variables analyzed by the Chi-square and continuous variables by t-tests. Multivariate logistic regression was performed to control for confounding. There were 30 participants: 73% with 1–5 years of experience, 40% with >100 prior intubations, 73% utilized mac 4 direct blade, and 60% prefer VL during cardiopulmonary resuscitation (CPR). Participants had first pass intubation success for all but one of the attempts with both modalities (NS). Participants more often expressed “high confidence” that intubation was successful for direct 60% versus video 77% (P = 0.2), but they more often rated the airway “difficult” for direct (40% vs. 10%; P = 0.01). Within bivariate analysis, mean time difference to intubate was less for DL versus VL (−6.8 s; P = 0.02). There were no significant associations between time differences to intubate for the following variables: experience (P = 0.6), >100 prior intubations (P = 0.8), blade size (P = 0.3), preferred technique (P = 0.8), high confidence successful DL (P = 0.5), high confidence successful VL (P = 0.7), rating of difficult view DL (P = 0.8), and rating of difficult view VL (P = 0.9). In the multivariate logistic regression with time difference as the dependent variable, there were no statistically significant independent variables. Several prior investigators have reported the success rates of endotracheal intubation with and without chest compressions.[1–5] Han etal. described that VL was superior to DL in simulated CPR settings and that interruption of chest compressions was seemingly unnecessary.[1,3] However, within our literature search, we did not find earlier studies comparing VL versus DL mCPR. In contrast to the findings of Han etal., we observed a lower mean time difference to intubation for DL versus VL during simulated mCPR in our current study, although such differences are unlikely clinically meaningful. On the other hand, participants in our study group were more confident that intubation was successful when using VL. The limitations of our study include single center site, small sample size, participants had varying prior intubation experience, and the high-fidelity Manikin may not replicate all the aspects of difficult intubation in the setting of actual CPR in the ED. Future studies evaluating DL versus VL during mCPR should be conducted in the clinical setting. Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

617: CANNABIDIOL GUMMY INGESTION LEADING TO CARDIAC ARREST IN A PEDIATRIC PATIENT

Introduction: Rising popularity and availability of cannabidiol (CBD) products have led to increased accessibility in homes. The resemblance of CBD gummies to candy has led to unintentional ingestions in pediatric patients. Toxic doses of CBD are unknown, and contamination with other cannabinoids and toxins can occur. Few reports describe CBD toxicity. Respiratory and neurologic depression are the main effects. Description: A 4-year-old 60kg male with a voracious appetite was found unresponsive at home. Parents report he ate half a 75mg CBD gummy approximately 6 hours prior to the event. At EMS arrival rhythm was a wide ventricular complex. At ED arrival the child remained pulseless with active cardiopulmonary resuscitation. Return of spontaneous circulation was obtained after approximately 20 minutes of downtime, though in a wide complex tachycardia. Labs demonstrated severe metabolic acidosis, hyperkalemia, and multiorgan dysfunction. Head CT showed diffuse cerebral edema and effacement of the sulci and basal cisterns. Shortly after transfer to our tertiary care center PICU he developed unequal pupils and received hyperosmolar therapies. He had no cough and no gag, corneal or pupillary reflexes. Electroencephalography demonstrated burst suppression pattern. Norepinephrine and epinephrine were started for hypotension. Echocardiogram showed poor biventricular function. Genetic testing for cardiomyopathies and arrhythmias was sent given the presenting rhythm. Given the neurologic exam and poor prognosis the family elected to withdraw life-sustaining therapies. A serum drug analysis was negative. A comprehensive urine drug analysis resulted 4 days later with carboxy-tetrahydrocannabinol (THC) >14,286 ng/mL, suggesting consumption of a substantial amount of CBD gummies containing THC. Discussion: The majority of CBD products are unregulated and can contain other cannabinoids, toxins, or synthetic equivalents, as shown in this case. CBD and synthetic equivalents do not result on traditional toxicology screens. Further testing may not be readily available, posing a diagnostic dilemma for practitioners. This case highlights the importance of considering CBD intoxication in patients who present with acute neurologic, respiratory, and cardiovascular depression.

Resuscitating the resuscitation: A single-centre experience on extracorporeal cardiopulmonary resuscitation.

Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of venoarterial extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation or in patients with intermittent return of spontaneous circulation. This study aimed to describe the demographic characteristics and outcomes of patients undergoing ECPR to identify survival-associated factors. The study was conducted in an extracorporeal life support centre of a tertiary hospital in Turkey and included all patients who underwent ECPR for in-hospital cardiac arrest between April 2013 and June 2021. Complications included bleeding, neurological injury, renal failure, hepatic failure, limb ischemia and bloodstream infections. The primary outcomes were survival of ECMO and survival to discharge. Neurological outcomes were assessed using the Pediatric Cerebral Performance Category Scale for children and the Category of Cerebral Performance Scale for adults. The study included 26 patients (24 paediatric, 2 adults), 22 (85%) of them had cardiac pathology. Bleeding was the most common complication. Twelve (46%) patients survived ECMO, 9 (35%) survived to discharge. Sex, age, primary diagnosis, cardiac arrest rhythm and ECMO duration were not significantly associated with the primary outcomes. Bleeding, neurological injury and renal failure were associated with poorer survival to discharge. The neurological outcomes of all survivors to discharge were good. ECPR is not commonly accessible. Sharing the experience of the few treating centres to date is crucial to accumulating sufficient knowledge about its efficiency and raising clinician awareness. This limited single-centre experience demonstrated the utility of ECPR.

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

U SO CARE-The Impact of Cardiac Ultrasound during Cardiopulmonary Resuscitation: A Prospective Randomized Simulator-Based Trial.

Background: Actual cardiopulmonary resuscitation (CPR) guidelines recommend point-of-care ultrasound (POCUS); however, data on POCUS during CPR are sparse and conflicting. This randomized trial investigated the effects of POCUS during CPR on team performance and diagnostic accuracy. Methods: Intensive Care and Emergency Medicine residents performed CPR with or without available POCUS in simulated cardiac arrests. The primary endpoint was hands-on time. Data analysis was performed using video recordings. Results: Hands-on time was 89% (87–91) in the POCUS and 92% (89–94) in the control group (difference 3, 95% CI for difference 2–4, p < 0.001). POCUS teams had delayed defibrillator attachments (33 vs. 26 sec, p = 0.017) and first rhythm analysis (74 vs. 52 sec, p = 0.001). Available POCUS was used in 71%. Of the POCUS teams, 53 stated a POCUS-derived diagnosis, with 49 being correct and 42 followed by a correct treatment decision. Four teams made a wrong diagnosis and two made an inappropriate treatment decision. Conclusions: POCUS during CPR resulted in lower hands-on times and delayed rhythm analysis. Correct POCUS diagnoses occurred in 52%, correct treatment decisions in 44%, and inappropriate treatment decisions in 2%. Training on POCUS during CPR should focus on diagnostic accuracy and maintenance of high-quality CPR.

Family opinion regarding their presence with the physicians during active cardio-pulmonary resuscitation of their relatives

Background: Family presence during resuscitation has been a controversial topic ever since it was first introduced. Despite claims that it may exaggerate the burden on health care workers, this practice is widely gaining attention and a lot of evidence refutes these claims. In fact, a number of international organizations have supported this practice as being useful and with a positive impact on family members. There is not a lot of research in this area in Saudi Arabia and we conducted this research with this aim. Methods: This was a cross-sectional study conducted in the Southern Region of Saudi Arabia and 1185 subjects were enrolled. After attaining formal consent, a pre-formulated questionnaire, formulated on themes from the literature review, was given to the subjects which addressed some basic questions about their opinions regarding family presence during cardiopulmonary resuscitation. Results: Out of the 1,185 respondents, 174 (14.6%) had witnessed Cardiopulmonary Resuscitation (CPR) of their relatives while 85.3% had never done so. This study demonstrated that more than half of the family members (58.9%) expressed a desire to be with their loved ones during resuscitation. While 587 (49.5%) people were concerned their presence in the treatment room may interfere in the medical help being provided to their relative, a slight majority i.e. 598 (50.3%) did not agree with this statement. When asked about the psychological impact of witnessing the CPR of their relative, 54.6% (650) people said it might affect them negatively in the long run while 45% (535) did not feel the same. Moreover, 609 (51.4%) did not feel their presence in the Emergency Room (ER) would help the patient in any way while 48.6% agreed that it may indeed do so. 69.8 % of attendants disagreed that they would interfere with the medical process if they were allowed to be present. Conclusion: This study supports that FPDR has shown promising benefits . Therefore, family members must be offered an option to witness the efforts of the medical team and their wishes must be respected and it is the duty of the health care institutions to facilitate this process . Key words: FPDR, family presence, Cardiopulmonary resuscitation, CPR

Inadvertent cannulation of the azygos vein during eCPR

Extracorporeal life support cannulation during active cardiopulmonary resuscitation (eCPR) is challenging at best. We report a CASE of inadvertent cannulation of the azygos vein during eCPR in a neonate.

Improving perception and confidence towards bystander cardiopulmonary resuscitation and public access automated external defibrillator program: how does training program help?

BackgroundIn conjunction with an automated external defibrillator (AED) placement program at various locations within a public university in Malaysia, a series of structured training programs were conducted. The objectives of this study is to (1) evaluate the effectiveness of a structured training program in improving the perception of the importance of AED and cardiopulmonary resuscitation (CPR), (2) evaluate the confidence of the employees in using an AED and performing bystander CPR, (3) identify the fears and concerns of these employees in using AED and performing CPR, and (4) determine the perception of these employees towards the strategy of the AEDs placed at various locations within the university.MethodsIn this single-center observational study, a validated questionnaire aimed to assess the university employees’ attitude and confidence in handling AED and performing CPR before (pre-test) and immediately after (post-test) the training program was conducted.ResultsA total of 184 participants participated in this study. Using the Wilcoxon signed-rank test, the training programs appeared to have improved the perception that “using AED is important for unresponsive victims” (z = 4.32, p < 0.001) and that “AED practice drills should be performed on a regular basis” (z = − 2.41, p = 0.02) as well as increased the confidence to perform CPR (z = − 8.56, p < 0.001), use AED (z = − 8.93, p < 0.001), identify victims with no signs of life (z = − 7.88, p < 0.001), and the willingness to perform CPR and AED without hesitancy (z = − 8.91, p < 0.001). Fears and concerns on performing CPR and using AED also appeared to have been significantly reduced, and the perception on placement strategies of these AEDs was generally positive.ConclusionUsing the theory of planned behavior as the explanatory framework, training programs appear to be helpful in improving the perception and the confidence of the participants towards performing CPR and using AED through the promotion of positive attitude, positive societal expectation, and a positive sense of empowerment. But whether this positive effect will translate into actual CPR performance and AED application in a real cardiac arrest is yet to be seen.

Anesthetic management of radical nephrectomy in patients with renal cell carcinoma involving renal vein or inferior vena cava.

To investigate the perioperative anesthetic management of patients diagnosed with renal cell carcinoma (RCC) metastasized into the renal vein or inferior vena cava (IVC) after undergoing radical nephrectomy to provide clinical evidence for rational anesthetic interventions. A total of 81 patients with RCC extending into the renal vein or IVC, aged 17-73 years, undergoing radical nephrectomy were recruited. Preoperative status, intraoperative management, average operation time, average estimated blood loss, postanesthesia outcomes, and postoperative complications were retrospectively analyzed. The mean operation time was 288 minutes (range 146-825 minutes). The mean estimated blood loss was recorded as 1905 mL (range 200-7000 mL). Among 81 cases, 9 patients (11.1%, 1 level II, 3 level III, and 5 level IV) were switched to undergo cardiopulmonary bypass. Significant hemodynamic fluctuations were observed in 39 patients who presented with level II-IV of tumor thrombus. One patient had pulmonary embolism and died of active cardiopulmonary resuscitation. The mean postoperative hospital stay was 12.8 days. Twenty-five cases with level III-IV tumor thrombus were transferred to the intensive care unit with endotracheal intubation due to massive intraoperative blood loss. The remaining 55 cases were transferred to the postanesthesia care unit 2 hours before being transferred to the ward. One patient had postoperative acute coronary syndrome and was discharged after effective interventions. Anesthetic management and intensive postoperative care play a pivotal role in the success of complete resection of RCC that metastasize into the IVC.

Ambulation With Femoral Arterial Cannulation Can Be Safely Performed on Venoarterial Extracorporeal Membrane Oxygenation

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support can be associated with significant deconditioning due to the requirement for strict bedrest as a result of femoral arterial cannulation. To address this issue, we evaluated our experience with ambulation in patients with peripheral femoral cannulation for VA-ECMO. All patients that were peripherally cannulated for VA-ECMO over a 2-year period were retrospectively reviewed. Patients that ambulated at least once while supported with VA-ECMO were included in the analysis. The primary outcomes were safety and feasibility of ambulation, defined as the absence of major bleeding, vascular, or decannulation events. Of 104 patients placed on VA-ECMO, 15 ambulated with a femoral arterial cannula. Forty-six percent of patients were placed on VA-ECMO for decompensated heart failure, and 54% for massive pulmonary embolism. Twenty-seven percent of patients were cannulated during active cardiopulmonary resuscitation. The median length of time from cannulation to out of bed was 3 (range, 0 to 26) days. The median length of time from cannulation to initial ambulation was 4 (range, 1 to 42) days. The median distance of the first postcannulation walk was 300 feet. Neither flow nor speed decreased during or after ambulation. There were no major bleeding events, vascular complications, or decannulation events associated with ambulation. The median intensive care unit length of stay and hospital length of stay were 12 and 21 days, respectively. One-year survival was 100% for ambulating patients. Ambulating patients supported with VA-ECMO, despite femoral arterial cannulation, appears feasible and safe in carefully selected patients.