Advanced Cardiac Life Support Research Articles

Nurses' Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial.

Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285.

Virgin unmarried scientist Elnaz Ghaffari is a volunteer to give birth in space on her space mission design: Ensuring safety during space missions

The title "Virgin, Unmarried Scientist Elnaz Ghaffari is a Volunteer to Give Birth in Space on Her Space Mission Design: Ensuring Safety During Space Missions" compellingly captures the groundbreaking nature of this mission and highlights Elnaz Ghaffari's unique commitment to advancing space science. It not only underscores the scientific and exploratory aspects but also brings a personal touch by mentioning her volunteerism and detailed design for safety. This title is clear, informative, and intriguing—sure to grab attention and spark curiosity about the mission, making it a great choice for communicating the innovative and inspirational goals of the project. The resuscitation and care of a mother-astronaut during space missions present unique challenges that necessitate meticulous planning and precise execution. This article outlines a comprehensive plan for managing maternal cardiopulmonary arrest, addressing critical steps such as high-quality CPR, advanced cardiac life support (ACLS), airway management, and preparation for potential cesarean sections. Additionally, it discusses the importance of fitness, nutrition, and fetal weight control for the mother-astronaut. The presence of a Crew Medical Officer (CMO), who is a trained astronaut with medical expertise, significantly enhances the safety and success of the mission. The article concludes with a detailed overview of the space mission program, emphasizing pre-flight, in-flight, and post-flight activities to ensure the safe return of both mother and neonate to Earth.

2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Evaluating the Effectiveness of Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) Training for Family Medicine Residents in Saudi Arabia

Evaluating the Effectiveness of Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) Training for Family Medicine Residents in Saudi Arabia

Digital Education for Health Care Providers: An Advanced Cardiac Life Support Resource

Advanced cardiovascular life support (ACLS) refers to a set of urgent treatment guidelines for cardiac emergencies to improve patient outcomes. Strong evidence supports online interactive content in facilitating student learning and engagement. This project introduces an innovative approach to ACLS education, namely a digital ACLS simulation to promote medical resident learning of relevant protocols. No similar resource was found in existing literature, supporting the potential merit of creating this tool for medical education. A scoping review was conducted on current ACLS guidelines to inform interactive content creation with MEDLINE [PubMED] and Web of Science. From this review, a decision tree based on validated care guidelines was derived, guiding digital application development. An online prototype was constructed in HTML, JavaScript, and CSS frameworks. The creation allows users to input cardiovascular emergency patient information and output relevant care instructions based on American Heart Association guidelines. Evidence-based descriptions were provided for each decision, referencing credible external resources for further learning. This interactive application may enhance ACLS protocol learning. Next steps include simulation testing with medical residents to establish whether statistically significant benefits are observed. Long term, this project may inform the development and revision of similar digital resources to enhance medical education delivery.

Abstract 4135335: A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: the EVIDENCE Study

Background: Refractory out-of-hospital cardiac arrest (OHCA) has poor outcomes. The benefit of expedited intra-arrest transport with ongoing resuscitation versus more extended on-scene resuscitation for refractory OHCA is not clear. Methods: In this Phase III, multi-center (15 hospitals), randomized, controlled trial conducted in Sydney, Australia, we assigned patients with refractory out-of-hospital cardiac arrest to receive either expedited intra-arrest transport, with mechanical cardiopulmonary resuscitation, to a cardiac catherization-capable hospital for coronary angiography and, where available, extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) or more extended on-scene conventional CPR (advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, initial rhythm VT/VF/PEA, and did not have a return of spontaneous circulation after 15 minutes of CPR, or three rounds of resuscitation. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. Analyses were performed on an intention-to-treat basis. Results: One hundred and ninety-seven (197) eligible patients were randomized (median age, 57.0 years; 77 [81%] men), 149 VT/VF (76%). Ninety-five were assigned to receive expedited transfer and 102 to receive conventional CPR. Ten patients in the expedited arms and 6 patients in the conventional arm received ECPR at hospital. At hospital discharge, 15 patients (14.7%) in the expedited transfer group (median on scene time 26 mins) were alive with a favorable neurologic outcome, as compared with 15 patients (15.8%) (median on-scene time 36 minutes). This treatment difference was small and statistically insignificant (risk difference -1.1% [95% CI: -12.2% to 10.0%]), adjusted relative risk 0.95 [p=0.87, 95% CI: 0.50 to 1.8]. Conclusions: Among patients with refractory out-of-hospital cardiac arrest, expedited intra-arrest transport did not significantly improve survival with neurologically favorable outcome at discharge compared with more extended on-scene resuscitation. However, clinically relevant differences could still be consistent with our results.

Abstract Su1206: Reduced Time to Goal Therapeutic Hypothermia With Implementation of a Post Cardiac Arrest Consult Service

Introduction: Critical care after advanced cardiac life support can be pivotal for survival and outcomes in patients with out-of-hospital cardiac arrest (OHCA). Prior studies have demonstrated improvements in survival after OHCA with shorter door-to-therapeutic hypothermia (TH) initiation times. Post-cardiac arrest consult teams (PCACT) can facilitate TH to goal 33°C and other aspects of post-arrest care. However, the effects of such a service on TH have not been consistently quantified. Hypothesis: More OHCA patients would undergo TH and reach goal temperature sooner following implementation of a PCACT. Aims: We aim to evaluate the effectiveness of a PCACT in optimizing TH in survivors of OHCA. Methods: We conducted a retrospective chart review of 305 patients admitted between January 1, 2021 and December 31, 2022. Implementation of a dedicated PCACT, comprised of a neurointensivist and an advanced practice provider or neurocritical care fellow, occurred on January 1, 2022. The PCACT was active on weekdays only. One year before and after this date were designated as “pre-PCACT” and “post-PCACT”, respectively. De-identified patient demographics, clinical features of cardiac arrest, and TH data were collected and compared using Wilcoxon rank-sum and Chi-squared tests for continuous and categorical variables, respectively. Results: Of the 305 patients admitted during the study period, 149 were in the pre-PCACT group and 156 were in the post-PCACT group. Baseline demographics between the two groups were similar except that the post-PCACT group had more patients with non-shockable rhythms (64% vs. 54%, p =0.001). Patients were not cooled to 33°C more frequently (50 vs. 52%) pre- or post-PCACT. TH to 33°C was performed in 156 (51%) patients, 78 patients (50%) pre- and post-PCACT implementation. There were no baseline demographic or temperature differences between the two groups amongst patients undergoing TH to 33°C. Post-PCACT patients were quicker to reach 33°C (1.6 vs. 3 hours, p =0.001). After PCACT implementation, this difference was noted during weekdays but not during weekends (1.3 vs. 2.7 hours, p =0.05).There were no differences in survival or neurologic outcomes pre- and post-PCACT introduction, nor between patients who were or were not cooled to 33C. Conclusion(s): Implementation of a PCACT may streamline care to reduce time to goal temperature during TH. However, further study is required to determine whether a PCACT can improve outcomes.

Abstract Su405: Effect Of A Visual Feedback Device On The Acquisition Of Cardiopulmonary Resuscitation Skills In Training Certified By The American Heart Association: Randomized Clinical Trial

Background: High-quality cardiopulmonary resuscitation (CPR) is fundamental for the success in the care of cardiorespiratory arrest. In CPR skills training, manequins with feedback on quality parameters have been employed and received varied evaluative results. The American Heart Association (AHA) encourages the use of feedback devices in CPR training; however, its effects have not been evaluated in courses certified by it. Research Questions: Training with visual feedback devices alters the learning of students in acquiring psychomotor skills in CPR? Goals: To evaluate the effect of a visual feedback device on CPR training, in AHA certified courses. Methods: A randomized clinical trial was conducted to estimate the intervention of a visual feedback device in practical CPR training for nurses, medical students and physicians in the Advanced Cardiovascular Life Support (ACLS) courses. For that, having as parameters the quality criteria determined by the AHA, we tried to compare the performance results of the trained students with objective feedback from the device and the trained students with subjective feedback from the instructor. Statistical analysis included chi-square test, Student's t test, Mann-Whitney u test, Spearman’s-rho correlation coefficient. Significance level considered was 0.05. A survey was registered with ClinicalTrials®, under resgistration NCT 04338490. Results: The sample consisted of 209 students; of these 119 (56.9%) were women, and 148 (70.8%) were physicians. The control group had 98 students, and the intervention group 111 students. The performance of students from both groups reached the criteria of quality in CPR. The group trained with a feedback device achieved, according to guidelines, better results in the rate of chest compressions, 78 (70.3%) versus 48 (49.0%), p &lt;0.01, and in return of the chest 100 (91; 100) versus 99 (78.25; 100), p &lt;0.03. As for the recommended compression fraction, 60% to 80%, both groups were above 60%; however, no student in the study reached 80%. Conclusions: The visual feedback device was effective in CPR training, improving students’ performance in the criteria of compression rates between 100 and 120/min and total return of the chest between compressions.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. The World Health Organization estimates that there are ≈236 000 deaths due to drowning worldwide each year. Significant efforts have focused on creating systems to prevent drowning, but an average of 4000 fatal and 8000 nonfatal drownings still occur annually in the United States-likely an underestimate. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, a boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Heart Association and the American Academy of Pediatrics. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Heart Association and American Academy of Pediatrics. The writing group used these reviews to update its recommendations aimed at resuscitation of cardiac arrest following drowning in adults and children.

Obstetric Life Support Education for Maternal Cardiac Arrest

Management of maternal cardiac arrest (MCA) requires understanding the unique physiology of pregnancy and modifications to life support. Health care professionals have historically demonstrated inadequate knowledge and skills necessary to treat MCA. To evaluate the effect of Obstetric Life Support (OBLS) education on health care professionals' cognitive performance, skills, and self-efficacy in managing MCA. In this single-masked randomized clinical trial, 46 health care professionals, including emergency medical service and hospital staff representing diverse specialties, were randomized to intervention or control groups at a single academic medical center in Farmington, Connecticut between May 1, 2022, and July 23, 2023. The intervention group received OBLS education, which included a blended learning curriculum with simulation-based training on common maternal medical emergencies that lead to MCA. Participants were assessed for knowledge, confidence, and skills (eg, megacode scores as team leaders during MCA simulations). Intervention participants were compared with control group participants who received no OBLS education. The primary outcome was cognitive scores. Secondary outcomes included megacode scores rated by experienced OBLS instructors masked to assignment groups, combined assessment pass rates, and cognitive and confidence scores at baseline and 6 and 12 months after education. Data were analyzed from January 2024 to May 2024. Forty-six participants (mean [SD] age, 41.1 [16.2] years; 24 [52%] women) were randomized. Despite most participants holding certification in basic and advanced cardiac life support, significant between-group differences were identified in knowledge, skills, and confidence. Mean (SD) cognitive scores were 79.5% (9.4%) in the intervention group vs 63.4% (12.3%) in the control group (P < .001). Mean (SD) megacode skills were higher in the intervention vs control group (91.0% [5.0%] vs 61.0% [12.0%], P < .001), as were confidence scores (72.7 [13.3] vs 56.2 [17.9] points, P = .002). Combined assessment pass rates were 90% in the intervention group compared with 10% in the control group (P < .001). In this randomized clinical trial, OBLS education significantly improved health care professionals' knowledge, skills, and confidence in managing MCA. These findings underscore the urgent need for implementation of a standardized MCA curriculum nationwide, especially as the US continues to face unacceptably high maternal mortality rates. ClinicalTrials.gov Identifier: NCT05355519.

CURRENT LEVEL OF KNOWLEDGE AND AWARENESS OF HEALTHCARE PERSONNEL IN BASIC AND ADVANCED LIFE SUPPORT IN ARREST CASES WITH AND WITHOUT COVID-19 INFECTION

Objective: The knowledge of healthcare professionals about life support is crucial for saving lives. It was aimed to evaluate the knowledge and awareness level of healthcare professionals about advanced life support. Materials and methods: Our study was conducted between 15.02.2021 and 15.03.2021 with healthcare personnel working in our hospital. Data were collected by the questionnaire method. The researcher prepared the survey questions according to the European Resuscitation Council COVID-19 guidelines and American Heart Association Advanced Cardiac Life Support algorithms updated in 2020. 265 healthcare personnel (physicians, physician assistants, family physicians, nurses, health officers, and anesthesia technicians) participated in the study. Demographic characteristics of the participants (gender, age, duration of service, duties, duty stations), training and practice status, and level of knowledge were evaluated. Results: 67.2% of the participants were female, and 32.8% were male. The majority of the participants were nurses working in the inpatient clinics. 49.9% had a tenure of 1-5 years. 52.0% had received advanced cardiac life support training, and 19.6% had obtained and used automatic external defibrillators. 63.8% had performed advanced cardiac life support on a patient. In our study, the general level of advanced cardiac life support knowledge of the participants was found to be low. There was no significant difference in advanced cardiac life support scores in terms of gender, age, occupation, workplace, and tenure (p=0.604; p=0.986; p=0.927; p=0.982; p=0.295, respectively). Conclusion: Providing in-service resuscitation training to healthcare workers in line with current guidelines and supporting them with practical applications can provide quality knowledge and skills and increase their awareness of their responsibilities.

Outcomes in patients with out-of-hospital cardiac arrest according to prehospital advanced airway management timing: a retrospective observational study.

In patients with out-of-hospital cardiac arrest (OHCA), guidelines recommend advanced airway (AA) management at the advanced cardiovascular life support stage; however, the ideal timing remains controversial. Therefore, we evaluated the prognosis according to the timing of AA in patients with OHCA. We conducted a retrospective observational study of patients with OHCA at six major hospitals in Daegu Metropolitan City, South Korea, from August 2019 to June 2022. We compared groups with early and late AA and evaluated prognosis, including recovery of spontaneous circulation (ROSC), survival to discharge, and neurological evaluation, according to AA timing. Of 2,087 patients with OHCA, 945 underwent early AA management and 1,142 underwent late AA management. The timing of AA management did not influence ROSC in the emergency department (5-6 minutes: adjusted odds ratio [aOR], 0.97; p=0.914; 7-9 minutes: aOR, 1.37; p=0.223; ≥10 minutes: aOR, 1.32; p=0.345). The timing of AA management also did not influence survival to discharge (5-6 minutes: aOR, 0.79; p=0.680; 7-9 minutes: aOR, 1.04; p=0.944; ≥10 minutes: aOR, 1.86; p=0.320) or good neurological outcomes (5-6 minutes: aOR, 1.72; p=0.512; 7-9 minutes: aOR, 0.48; p=0.471; ≥10 minutes: aOR, 0.96; p=0.892). AA timing in patients with OHCA was not associated with ROSC, survival to hospital discharge, or neurological outcomes.

Effects of Perfusion, Coronary Artery Disease Burden, and Revascularization in Establishing Organized Cardiac Rhythm During Extracorporeal Cardiopulmonary Resuscitation for Shockable Refractory Out-of-Hospital Cardiac Arrest.

Two hundred eighty-nine consecutive patients in refractory shockable OHCA were placed on ECMO followed by coronary angiogram (n=289) and PCI (n=165). Patients were grouped based on the extracorporeal cardiopulmonary resuscitation stage where a sustained organized rhythm was achieved. Survival outcomes were evaluated by using the Cerebral Performance Category. Logistic regression analysis was performed to determine the relationship between Cerebral Performance Category and timing of organized rhythm. Standard advanced cardiac life support before hospital arrival resulted in 148 of 289 (51%) patients attaining an organized rhythm while 87 of 289 (30%) achieved an organized rhythm post ECMO cannulation but before PCI, and 37 of 289 (13%) achieved an organized rhythm following PCI. Obstructive coronary artery disease was observed in 192 of 289 (66%) patients. A total of 144 of 192 (75%) patients with obstructive coronary artery disease converted to an organized rhythm before PCI and 37 of 192 (19%) following PCI. Cerebral Performance Category score 1 or 2 was significantly more likely in patients with cardiac arrest and obstructive coronary artery disease who achieved an organized rhythm before PCI (odds ratio [OR], 3.9 [95% CI, 1.2-12.0], P=0.024). Most patients undergoing extracorporeal cardiopulmonary resuscitation for refractory OHCA due to shockable rhythms achieved an organized rhythm before PCI independent of coronary artery disease burden. Also, neurologically favorable survival was more prevalent in those attaining an organized rhythm before PCI.

The Emergency Leadership Dashboard: A Comprehensive System for Visualizing Operations across Educational, Administrative, and Research Sectors

Introduction Managing patient care and fulfilling administrative tasks are challenges facing healthcare systems (1). Particularly at university hospitals, emergency departments (EDs) must carry out research and fulfill educational responsibilities. As a result of these responsibilities, educators can develop educator burnout (2). Providers must additionally maintain accreditation by completing continuous education and certification. Using new technology and automation, clinicians can focus on patient care and quality service, reducing administrative burdens. The goal of this study is to introduce an ED leadership dashboard that optimizes ED operational efficiency across the administrative, educational, and research areas. Methodology The digital dashboard was developed with Microsoft Teams, Forms, Excel, and Power BI. The system combines multiple datasets to create a comprehensive visual dashboard. The first database queries information about ED physicians and updates the related datasets, including ED research, administrative tasks, student evaluations, and performance metrics. The real-time updates and visualization on the dynamic Power BI dashboard facilitate the shift from the current paper-based data collection to an electronic workflow. Implementation includes utilizing standardized forms for data inputs about research projects, educational assessments, and administrative tasks, such as complaint management and credential monitoring. These inputs cause updates in the respective datasets and dashboard output in real time, which enhances the decision-making process by providing immediate access to performance metrics such as patient throughput. The dashboard ensures consistency, improves administrative efficiency, and supports a proactive approach to management and educational evaluations within the ED. Results The research dashboard monitors research activities, allows users to select by year and quarter, and displays interactive visualizations. Projects are categorized into "Original Research" and "Case Report," with Original Research being more common. The stages of research (Writing, Analysis, and Data Collection) are depicted in a donut chart, where Data Collection was found to be the most prevalent. The status of the projects is shown as "On Track," "Completed," or "Delayed," with most projects currently on track. An analysis of research types showed that Retrospective studies were the most frequent (Figure 1). The physician's involvement in each project is also tracked to distribute the project load among faculty. The training and certification dashboard shows completion rates for certifications such as Basic Life Support and Advanced Cardiovascular Life Support, with most completion rates near perfect. Safety training showed a low completion rate of 35%. 574 certifications were completed, and 10 were pending, for an overall 98% completion rate. (Figure 2) Figure 1: Research Dashboard Figure 2: Certification Dashboard Conclusion The implementation of an ED leadership dashboard in university hospital emergency departments has markedly enhanced operational efficiency across administrative, educational, and research functions. Utilizing technologies like Microsoft Teams, Forms, Excel, and Power BI, the dashboard has transitioned from paper-based systems to a streamlined electronic workflow, enabling real-time data visualization and updates. This has improved decision-making processes, optimally distributed faculty workloads, and maintained high certification completion rates, while also highlighting areas for improvement such as safety training. Overall, the dashboard has effectively managed patient care and administrative tasks, reducing burdens and supporting proactive management within the emergency department.

The evaluation of video-assisted debriefing for improving performance in simulated medical student resuscitations.

Simulation-based training is commonly used in medical education. However, there is a gap in knowledge regarding best practices in debriefing. We aimed to identify novel solutions to this by adapting video-assisted debriefing (VAD) methodologies used in athletic training. We hypothesized that utilizing VAD would lead to improvements in performance during advanced cardiac life support (ACLS)-based simulations compared to traditional verbal debriefing (VD). The study was conducted at a single medical school. Participants were fourth-year medical students engaging in ACLS simulation-based training as part of their emergency medicine rotation. After completing an ACLS-based simulation, participants received either VD or VAD and then completed a second simulation scenario. Our primary outcome was ACLS performance, graded by blinded reviewers utilizing a previously developed modified checklist. Secondary outcomes included time from cardiac arrest to initiation of cardiopulmonary resuscitation (CPR) and first defibrillation. Measurements were made before and after the interventional debrief, referred to as pre- and postdebrief. A modified Likert-scale survey was used to subjectively assess the student's overall experience. Forty-six groups of 275 students were included in the study. Mean ACLS performance score for VD and VAD postdebrief were 85% and 82%, respectively (p = 0.27). Mean time from arrest to CPR initiation for VD and VAD postdebrief groups were 20 and 24 s, respectively (p = 0.46). Mean time from arrest to defibrillation for VD and VAD postdebrief groups were 50 and 59 s, respectively (p = 0.39). For the Likert surveys, 85% or more of participants in both groups indicated that the session was "very helpful" in all survey categories. VD and VAD both led to improvements in ACLS performance, time to initiation of CPR, and defibrillation among fourth-year medical students. Though postdebrief results were not statistically significantly different by comparison, overall VD led to greater improvement overall across all outcomes.

Going in Blind: A Common Scenario in an Uncommon Situation.

Medical students, interns, junior resident physicians, senior resident physicians. Power outages have been increasing in frequency in the past few years, therefore becoming an increased threat to healthcare delivery.1 While most studies related to the effects of power outages are focused on outpatient care, such as acute exacerbations of chronic lung conditions and the lack of chargeable equipment, with the increasing number of power outages, hospitals must be prepared for this situation as well.2,3 Although agencies such as the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) have provided guidelines for the response of hospitals to temporary loss of power,12,13 hospitals generally rely on institutional policies in response to the event of a power outage. Given the relative rarity but increasing frequency of power outages in hospital settings, this medical simulation was created to present a common occurrence in the emergency department (eg, cardiac arrest) in an uncommon setting of a power outage. Simulation has been shown to improve learner self-efficacy, confidence, and leadership skills among resuscitation teams.4,5 The role of simulation also helps learners identify latent safety threats, in this case a power outage.6 The goal of this simulation is to improve the skills of healthcare professionals with regards to managing cardiac arrest and to encourage these practitioners to consider their own hospital guidelines in response to a power outage. By the end of this simulation, learners will be able to (1) evaluate and treat a patient experiencing myocardial infarction and subsequent cardiac arrest during a power outage, (2) describe the local protocols for managing patient care during a power outage, (3) demonstrate the ability to coordinate a medical team during a simulated power outage in an emergency department with limited resources, (4) manage a cardiac arrest patient by following Advanced Cardiac Life Support (ACLS) protocols for bradycardia and ventricular fibrillation, and (5) justify the urgency of transfer to a certified ST segment elevation myocardial infarction center/cardiac intensive care unit, referencing the recommended 120-minute door-to-balloon time. This simulation was conducted with a high-fidelity mannequin. A total of six residents of various post-graduate year (PGY) levels participated in the simulated patient encounter as part of the simulation competition at the Western Regional meeting of the Society for Academic Emergency Medicine. This case was assessed for educational content and piloted by emergency medicine attendings from several institutions prior to running the case for the Western Regional meeting. The efficacy of the content was assessed by oral feedback. The case was well-received by both the attending physicians who evaluated the case prior to running the scenario at the Western Regional meeting and the emergency medicine residents who participated in the case at the Western Regional meeting. Overall, this simulation was well received by both the learners and the debriefers. General feedback was positive, with the perception of increased confidence among learners and reflection upon individual hospital policy in the event of a power outage. Simulation, acute myocardial infarction, cardiac arrest, power outage.

How to perform Point of Care Ultrasound at resuscitation and when it is useful.

Point of Care Ultrasound (POCUS) can be useful as a tool before, during and after the performance of cardiopulmonary resuscitation (CPR). Before or after resuscitation it can help with monitoring unstable hemodynamics, has the potential to identify reversible causes if patient deteriorates. During resuscitation POCUS can help detect potentially treatable causes of the cardiac arrest. Performance of POCUS while resuscitation requires experienced sonologists and a good team structure to embed the examination in advanced cardiovascular life support (ACLS) algorithms. This article gives an overview and tips about how to detect potential reversible causes of patient deterioration in all three phases of CPR. We describe some special situations in which resuscitation could take place. Further we give a comment about sonographic education of physicians and nonacademic medical staf.

Advanced cardiac life support in out-of-hospital cardiac arrest: A case study

Background: Public Health Center (PHC), especially in rural areas, is one of the primary healthcare facilities that have an important role in the chain of survival of out-of-hospital cardiac arrest (OHCA) patients. Despite of limited facilities, prehospital resuscitation can be performed by optimizing the available emergency facilities and infrastructure. Purpose: To provide a comprehensive overview of the resuscitation management of OHCA patients at a PHC in East Java Province in Indonesia. Method: Case study of a 43-year-old woman who was brought to PHC by residents after suddenly losing consciousness while working. The clinical condition when the patient arrived was unresponsive, no pulse, no respiratory effort, cold extremities, and oxygen saturation of 80%, the patient was medically diagnosed as OHCA. Results: Resuscitation organization was carried out by involving 1 doctor, 2 nurses, and 1 midwife. The patient was given basic life support (BLS) and Advanced Cardiac Life Support (ACLS) by optimizing diagnostic tools, airway, breathing, circulation, and available drugs. The patient successfully Return of Spontaneous Circulation (ROSC) after the third cycle and successfully reached the referral hospital to receive further life support. Conclusion: ACLS in the prehospital setting at PHC in Indonesia has a potential to be performed. Inter-professional collaboration, airway, breathing, and circulation optimization in providing BLS and ACLS on OHCA patients can increase the patient's chance of getting further care in the hospital.