Advanced Cardiac Life Support Research Articles

Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19.

This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.

Personal Protective Equipment Efficiency in Healthcare Emergencies: A Single-Center Experience.

Coronavirus disease 2019 (COVID-19) has dramatically shifted the healthcare landscape since 2020. Measures against it includes universal masking in the healthcare areas and the community, viral testing before aerosolizing procedures, and ambulatory elective surgical procedures. Some hospitals have had mandated viral testing policies even before admission to the hospital. Healthcare workers (HCWs) have been cautiously modifying all pertinent practices to avoid the transmission of the virus.Personal protective equipment (PPE), including gowns, gloves, eye protection, and properly fitted N95 respirator or powered air-purifying respirators (PAPR) while treating the suspected and confirmed COVID-19 patients were made mandatory. Similarly, we changed our aerosol-generating procedures (AGPs) protocols based on available limited data. We amended our approach to in-hospital cardiopulmonary resuscitation (basic life support (BLS)/advanced cardiovascular life support (ACLS)), given the risk of aerosol generation and transmission during the process. This article shares our experience and outcomes of PPE use in healthcare emergencies at our tertiary care academic center.

Communication Skills Training Using Remote Augmented Reality Medical Simulation: a Feasibility and Acceptability Qualitative Study.

IntroductionAugmented reality (AR) has promise as a clinical teaching tool, particularly for remote learning. The Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator with a holographic patient and monitor. The primary aim was to analyze feedback from medical and physician assistant students regarding acceptability and feasibility of the simulator.MethodsUsing the CHARM simulator, we created an advanced cardiovascular life support (ACLS) simulation scenario. After IRB approval, preclinical medical and physician assistant students volunteered to participate from August to September 2020. We delivered augmented reality headsets (Magic Leap One) to students before the study. Prior to the simulation, via video conference, we introduced students to effective communication skills during a cardiac arrest. Participants then, individually and remotely from their homes, synchronously completed an instructor-led ACLS AR simulation in groups of three. After the simulation, students participated in a structured focus group using a qualitative interview guide. Our study team coded their responses and interpreted them using team-based thematic analysis.ResultsEighteen medical and physician assistant students participated. We identified four domains that reflected trainee experiences: experiential satisfaction, learning engagement, technology learning curve, and opportunities for improvement. Students reported that the simulator was acceptable and enjoyable for teaching trainees communication skills; however, there were some technical difficulties associated with initial use.ConclusionThis study suggests that multiplayer AR is a promising and feasible approach for remote medical education of communication skills during medical crises. Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-022-01598-7.

Effects of a Designated Ambulance Team Response on Prehospital Return of Spontaneous Circulation and Advanced Cardiac Life Support of Out-of-Hospital Cardiac Arrest: A Nationwide Natural Experimental Study

Objectives This study aimed to investigate the effects of adding advanced cardiac life support (ACLS) training to an existing basic life support program and the operation of a designated team response for patients with out-of-hospital cardiac arrest (OHCA) on prehospital return of spontaneous circulation (ROSC) and ACLS management. Methods A natural experimental study was conducted for emergency medical service (EMS)-treated adult patients with OHCA in 2020. In 2019, a quarter of the EMS clinicians were trained in a 3-day ACLS courses, and they were designated to be dispatched first in suspected OHCA. Some were dispatched only to major emergencies, such as OHCA and myocardial infarction (dedicated team), while others were dispatched to all emergencies with priority to major ones (non-dedicated team). The exposure was the ambulance response type: dedicated, non-dedicated, and basic teams (others). The primary outcome was prehospital ROSC. The secondary outcomes were prehospital ACLS (advanced airway management and intravenous access). A multivariable logistic regression analysis was conducted to investigate the effect of ambulance response type on study outcomes. Results Among 23,512 eligible patients with OHCA, 54.8% (12,874) were treated by the basic team, 36.5% (8,580) by the non-dedicated ACLS team, and 8.8% (2,058) were treated by the dedicated ACLS team. Prehospital ROSC was greater for the designated team than for the basic team (dedicated ACLS team 13.8%, non-dedicated ACLS team 11.3%, and basic team 6.7%) (p < 0.01). In the final logistic regression analysis, compared with the basic team, the designated ACLS team was associated with a higher probability of prehospital ROSC (AOR (95% CIs), 1.88 (1.68–2.09) compared to the non-dedicated ACLS team, and 2.46 (2.09-2.90) compared to the dedicated ACLS team), prehospital advanced airway management (1.72 (1.57-1.87) and 1.73 (1.48-2.03), respectively), and intravenous access (2.29 (2.16-2.43) and 2.76 (2.50-3.04), respectively). Conclusion Additional ACLS training and operation of a designated OHCA team response were associated with higher rates of prehospital ROSC and prehospital ACLS provision. However, further research is needed to find the optimal operation for EMS to improve survival outcomes.

Assessment of Knowledge on Basic Life support and Advanced Cardiac Life Support in a Medical College of Kathmandu

Introduction: Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) are part of cardio-pulmonary resuscitation. The knowledge of BLS and ACLS is very important in saving lives for healthcare workers for which they need training and updated knowledge on these topics. The aim of the study was to assess the knowledge on BLS and ACLS in a medical college of Kathmandu. Methods: This was a cross sectional retrospective study conducted in Nepalese Army Institute of Health Sciences. The pretest and posttest scores of the trainees who participated in BLS and ACLS training were analyzed to assess the improvement in the knowledge. The duration of the study was from 1st May 2021 to 31st October 2021 where two sessions of the training were conducted. Data were entered in Microsoft Excel and analysis was done in Statistical Package for Social Sciences version 16. Results: Out of 72 participants, the mean pretest score was 5.67 ± 1.91 (56.67%) on BLS (Total score 10) and 9.06 ± 2.21 (60.37%) on ACLS (Total score 15). Post-test scores for BLS and ACLS were 8.69 ± 1.03 (86.94%) and 11.43 ± 1.77 (76.20%) respectively. Statistically significant increase in the mean scores were seen in both BLS [df (71) = -13.532, p &lt; 0.001] and ACLS ([df (71) = -9.956, p &lt; 0.001] with 95% CI while comparing pretest BLS and ACLS with posttest BLS and ACLS scores. Conclusions: Improvement in knowledge was seen amongst participants after the training. This highlights the importance of such training in imparting knowledge regarding BLS and ACLS among healthcare personnel.

Awareness of Cardiopulmonary Resuscitation amongst Interns and Resident Doctors: A Cross Sectional Analysis in a Tertiary Care Hospital in Northern India

Background: Knowledge of basic and advanced cardiac life support is of paramount significance amongst health care professionals to attain higher survival rate of patients suffering from sudden cardiac death. Objectives: To determine the awareness and knowledge for performing high quality CPR amongst junior resident doctors in a tertiary care hospital. Methods: In a prospective cross-sectional study, 220 preformed questionnaires were distributed amongst the interns, postgraduate and non-postgraduate junior resident and senior resident doctors, with a response rate of 69% (n-152). Data on the responders awareness of cardipulmonary resuscitation (CPR), core knowledge of basic life supoort (BLS) and advanced cardiac life supoort (ACLS) were collected. Data was subjected to descriptive and inferential statistical analyses using SPSS version 23.0 and was expressed as mean ± standard deviation or in percentage. A p-value ≤ 0.05 was considered as significant level. Results: Among the 152 responders, 31(20%) were interns, 74(49%) were postgraduate course junior residents (PG JR), 7(5%) were non- post-graduate course (Non-PG JR) and 40 (26%) were senior resident (SR) doctors. Only 24% (n-36) of doctors have done previous certified CPR training course. The awareness of resuscitation amongst all doctors was 71% and observed highest amongst the PG JRs 73%. The core knowledge of BLS and ACLS was only 47% and 44% respectively, amongst all doctors. Conclusion: Majority of resident doctors have limited knowledge of basic concept of BLS and ACLS guidelines. A well structured and evidence based format of CPR training should be incorporated in training modules for better outcome.

Application of 3D Printing in Training Health Care Providers; the Development of Diverse Facial Overlays for Simulation-Based Medical Training.

The medical simulation manikins used by healthcare learners provide the training of numerous clinical skills but often lack diversity with respect to race, ethnicity, age, and sex. Having a diverse medical education environment is imperative for exposing learners to the diverse population of patients they may encounter when in practice. In this technical report, the development of diverse and cost-effective facial overlays produced using 3D scanning, 3D printing, and silicone to be used on top of the current medical manikins at Lakeridge Health Hospital (Oshawa, Ontario, Canada) is described. To obtain consistent feedback throughout the development process, an advisory committee was consulted monthly at Lakeridge Health Hospital. The process began by determining that two facial overlays would be developed based on the two groups that represent the highest percentage of visible minorities in the Durham Region (Ontario, Canada). Facial overlays representing the South Asian (31.8%) and Black (29.6%) races were chosen. To prevent the generalizability of the facial features of these two races, volunteers who identified as specific ethnicities (East Indian and Jamaican) within each race were selected. To add variation in age for the facial overlays, the East Indian facial overlay was edited to represent an adolescent teenager (15 to 17 years old) and the Jamaican overlay was edited to represent an elderly citizen (over 60 years old). The facial overlays were developed from the 3D scans of the two volunteers and were used to create the design of 3D printed molds, in which silicone was poured in. Pigments were added to the silicone to match the skin tones of the two volunteers, and these specific tones were used as the base color for each facial overlay. Details, such as wrinkles, eyebrows, and lip color, were painted on top of the base using additional pigmented silicone. Additionally, neck overlays were created to provide continuity of the skin tone of the facial overlay. To retain the functionality of the medical manikins, the eyes of the facial overlays were cut out, and the mouth was cut open to allow for intubation training. For stability purposes, Velcro attachments were added to the facial and neck overlays so that they could be secured onto the medical manikins. Overall, the costs to manufacture both facial overlays resulted in CAD 235.65, including local taxes. Once manufactured, both facial overlays were tested by medical students (n=18) during two separate advanced cardiovascular life support (ACLS) training sessions in the local, hospital-based simulation laboratory at Lakeridge Health Hospital. The feedback obtained suggested a need to improve the functionality of the facial overlays by making the mouths bigger and less stiff for easier intubation. However, the overlays were accepted overall as a means to add diversity to the current medical manikins. In the end, cost-effective and diverse facial overlays were created to be used on top of the medical manikins that are currently being used by healthcare learners at Lakeridge Health Hospital.

Knowledge, attitudes and awareness of Cardiopulmonary Resuscitation in physiotherapists of Karachi–A Cross-sectional Survey

Objective: To study and relate the level of knowledge and attitude regarding CPR in medical faculty of Karachi. Research Design: This was an observational, cross-sectional survey based study. Duration: December, 2020 to January, 2021. Methodology: This study was conducted in various private and public sector hospitals and private rehabilitation centers in Karachi. This was an observational, cross-sectional, survey based study designed to assess CPR knowledge. Data was collected using a self–structured questionnaire comprising of thirty one close-ended questionnaire having 3parts: Q.1-7 Demographics; Q.8-20 CPR Practices and Q.21-31 Knowledge of CPR. Result: Total Sample of 126 individuals (n=126) was selected for the study. The analysis was done by using SPSS version 22. The P value (&gt;0.05) indicates that the outcomes were insignificant indicating the knowledge of CPR in Karachi. Conclusion: The general awareness regarding CPR was good but first aid skills needs improvement. Professional training programs, hands-on workshops, should be conducted to enhance CPR skills, awareness and knowledge among medical faculty. Keywords: Cardiopulmonary Resuscitation (CPR), Advanced Cardiac Life Support (ACLS), ventricular fibrillation (VF), AHA (American Heart Association), ERC (European Resuscitation Council)

Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the PICU: A Multicenter Survey.

Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. Actual practice patterns are unknown. Multicenter cross-sectional survey regarding institutional practices for the transition from weight-based to flat dosing of epinephrine during cardiopulmonary resuscitation in PICUs. Exploratory analyses compared epinephrine dosing practices with several institutional characteristics using Fisher exact test. Internet-based survey. U.S. PICU representatives (one per institution) involved in resuscitation systems of care. None. Of 137 institutions surveyed, 68 (50%) responded. Most responding institutions are freestanding children's hospitals or dedicated children's hospitals within combined adult/pediatric hospitals (67; 99%); 55 (81%) are academic and 41 (60%) have PICU fellowship programs. Among respondents, institutional roles include PICU medical director (13; 19%), resuscitation committee member (23; 34%), and attending physician with interest in resuscitation (21; 31%). When choosing between weight-based and flat dosing, 64 respondents (94%) report using patient weight, 23 (34%) patient age, and five (7%) patient pubertal stage. Among those reporting using weight, 28 (44%) switch at 50 to less than 60 kg, 17 (27%) at 60 to less than 80 kg, five (8%) at 80 to less than 100 kg, and eight (12%) at greater than or equal to 100 kg. Among those reporting using age, four (17%) switch at 14 to less than 16 years, five (22%) at 16 to less than 18, and six (26%) at greater than or equal to 18. Twenty-nine respondents (43%) report using ideal body weight when dosing epinephrine in obese patients. Using patient age in choosing epinephrine dosing is more common in institutions that require Advanced Cardiac Life Support (ACLS) certification for some/all code team responders compared with institutions that do not require ACLS certification (52% vs 22%; p = 0.02). The majority of PICUs surveyed report epinephrine dosing practices that are inconsistent with PALS guidelines.

P144 Effect of designated ambulance team on prehospital return of spontaneous circulation and prehospital advanced cardiac life support of out-of-hospital cardiac arrest: nationwide observational study

P144 Effect of designated ambulance team on prehospital return of spontaneous circulation and prehospital advanced cardiac life support of out-of-hospital cardiac arrest: nationwide observational study

SURVIVING AGAINST ALL ODDS: A CASE OF MULTI-ORGAN FAILURE IN THE SETTING OF COVID-19

TYPE: Late Breaking Case Report TOPIC: Critical Care INTRODUCTION: COVID-19 is a novel virus and our understanding of the infection is still evolving. Even though may remain asymptomatic, severity of disease can vary from mild symptoms to multi-organ failure. We report an African-American female who survived severe multi-organ failure secondary to COVID-19. CASE PRESENTATION: 67-year old female with a past medical history significant for coronary artery disease was admitted to the ICU with respiratory failure requiring intubation and mechanical ventilation secondary to COVID-19 pneumonia. Her course was complicated by renal failure requiring renal replacement therapy. She developed septic shock requiring pressors, PEA cardiac arrest requiring advanced cardiac life support, disseminated intravascular coagulopathy, and upper gastrointestinal bleed. She received 30 units of packed red blood cells and multiple platelet and cryoglobulin transfusions. She also developed recurrent episodes of sustained bradycardia and sinus pauses for up to 1 minute, thus requiring a pacemaker. She underwent tracheostomy and percutaneous endoscopic gastrostomy tube placement. She was discharged to a subacute rehabilitation facility where she was successfully liberated from the ventilator. She is home and fully independent of her activities of daily living. DISCUSSION: Anticipated clinical course for this patient was initially grim as she endured a very complicated hospital course. The case demonstrated the difficult prognostication of COVID-19, especially in the setting of being a novel disease. CONCLUSIONS: Mortality for patients on prolonged mechanical ventilation is very high; however, without prior knowledge of COVID-19 and its long term effects, it is important to understand the potential for full recovery even against all odds as this case illustrates. DISCLOSURE: Nothing to declare. KEYWORD: covid

The Role of Ultrasound Examination in the Differential Diagnosis of Cardiac Arrest in Prehospital Care: A Case Report

The survival rate of patients with out-of-hospital cardiac arrest has improved in recent years; however, it remains low. One approach to improving outcomes in these cases is to implement point-of-care ultrasound as an integral part of advanced cardiac life support management. Due to its growing popularity among emergency physicians, several protocols for this examination have been developed; however, there are little data on its use in the prehospital setting. We present a case report on the role of ultrasound examination in cardiac arrest for both diagnostic and therapeutic management.

EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions

EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions

Vagal Stimulation Causing Intra-operative Cardiac Arrest, A Major Dilemma Whether to Proceed or to Defer Surgery: A Case Report

Vagal stimulation under general anesthesia can lead to life-threatening bradycardia and cardiac arrest. Here we present two cases of cervical carcinoma and tongue carcinoma, developing intra-operative cardiac arrest due to severe vagal stimulation, treated and resuscitated as per Advanced Cardiac Life Support protocol followed by clinical evaluation along with 12 lead electrocardiogram, arterial blood gases and screening echocardiogram, and completion of surgery. Also, we stress that intra-operative cardiac arrest is a dreadful consequence of severe vagal bradycardia leading to asystole, which needs to be recognized early and treated promptly followed by thorough clinical assessment and a decision regarding whether to proceed or abandon the surgery. This kind of cardiac arrest due to severe vagal stimulation which is resuscitated with minimal intervention may not call for deferring the surgical procedure if the evaluation done clinically together with tools of electrocardiogram, arterial blood gases, and screening echocardiogram are within the normal range.

Resuscitating Learner Satisfaction: Enhancing ACLS Pharmacology Education Through a Case‐Based Escape Room Simulation

BackgroundTraining in Advanced Cardiac Life Support (ACLS) is a vital component of medical education. However, data suggests that learners are not satisfied with traditional ACLS learning formats and quickly lose mastery of the pharmacologic knowledge obtained. Prior studies have shown high learner satisfaction and knowledge mastery related to the ‘gamification’ of learning sessions. We hypothesize that the utilization of an online pre‐session learning module followed by a case‐based escape room simulation will lead to high levels of learner knowledge, satisfaction, and confidence in ACLS pharmacology.MethodsAll fourth‐year medical students (n=112) in the Class of 2021 participated in an online pre‐session module and escape room activity. Initially, all students completed a short (16‐minute) online learning module designed to teach the basics of ACLS pharmacology. After this module, students completed a 28‐item pre‐session MCQ quiz to assess baseline knowledge and to ensure preparation for the escape room activity. Students then completed a high‐fidelity case‐based escape room activity consisting of six ten‐minute stations incorporating simulators, puzzles, and clues related to ACLS relevant pharmacologic concepts and algorithms. After the activity, students completed the same 28‐items as a post‐session MCQ quiz and a 14‐item satisfaction/confidence survey. Pre‐ and post‐session results were compared via paired t‐tests.ResultsAll 112 participants (RR=100%) completed both the pre‐ and post‐session knowledge assessments. Overall mean performance on pre‐ and post‐session assessments was 87.6% (SD 8.4) vs. 95.7% (SD 5.0), respectively (Table 1, p&lt;0.0001). Mean pre‐ and post‐session performance on pharmacology specific items was 77.7% (SD 11%) and 92.8% (SD 9.5%), respectively (Table 1, p&lt;0.0001). 111 participants (RR=99%) completed the post‐session confidence survey. On a 7‐point Likert scale (1‐“Strongly Disagree” through 7‐“Strongly Agree, ”Figure 1), mean agreement with the statement “The ACLS module improved my knowledge of medical decision making for patients in cardiac arrest” was 6.6 (SD 0.8). On a 10‐point Likert scale, students rated their pre‐ and post‐session confidence in “Addressing a patient in cardiac arrest” at 7.7 (SD 2.1) and 8.4 (SD 1.6), respectively (p=0.0019).ConclusionParticipation in the online pre‐session module and escape room activity led to significant knowledge gains in ACLS pharmacology along with high levels of learner confidence and satisfaction. This innovative approach may be used to teach ACLS pharmacology to fourth‐year medical students and to supplement traditional ACLS certification courses.

When Adenosine Does Not Work: Apparent and Real Adenosine-Resistant Tachycardia.

Supraventricular tachycardia (SVT) is the most common arrhythmia in the pediatric population. Adenosine is widely accepted as the first-line pharmacological treatment for hemodynamically stable SVT, constituting a class I recommendation in the 2020 American Heart Association guidelines for pediatric life support (2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care). As most pediatric SVTs are dependent on the atrioventricular node (AVN) for their propagation, and adenosine acts primarily on the AVN, adenosine will frequently terminate the arrhythmia. The term "adenosine failure" is often used to describe when its administration does not result in sustained termination of the tachycardia. Because of its very short half-life, there is confusion between improper delivery, failure to have any effect on the tachycardia, or transient termination. There are some pediatric SVTs, which are not AVN dependent, and which truly are refractory to adenosine. Simultaneous electrocardiogram recording during administration can provide important information to differentiate between adenosine resistance and transient adenosine effect, thus guiding further management.

Two Cases of BRASH Syndrome: A Diagnostic Challenge.

Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is a relatively new clinical entity. It is often underrecognized, underdiagnosed, and confused with other causes of bradycardia. Treatment of BRASH syndrome differs from the standard bradycardia algorithm in advanced cardiac life support (ACLS), and the cornerstone management remains treating the hyperkalemia, improving renal function by treating the underlying cause, withholding AV nodal blocking agents, and considering dialysis in refractory cases, as any single factor could precipitate the vicious cycle. Here we describe two cases of BRASH syndrome with different clinical presentations that were treated with conservative management: one case in a 77-year-old Japanese woman and the other in an 86-year-old man.LEARNING POINTSBRASH syndrome is an underrecognized clinical entity that healthcare providers need to be aware of. A medication review, particularly of cardiac medications, including AV nodal blocking agents, is critical for diagnosing BRASH syndrome.The management principles of BRASH syndrome are conservative management, addressing the precipitating event or medications and correcting electrolyte derangements.The prognosis of BRASH syndrome is excellent with timely recognition and management.

Sedative Choice: The Chilling Confounder to Targeted Temperature Management.

Targeted temperature management (TTM) is a technique used in adults who lack a meaningful response after the return of spontaneous circulation following cardiac arrest (CA). The implementation of TTM is believed to improve neurological outcomes by decreasing cerebral metabolism, reducing apoptosis, and lowering oxygen demand. While this technique is recommended as a part of advanced cardiovascular life support (ACLS), there is a lack of consistency regarding drug choice and depth of sedation in TTM. In this report, the authors provide a review of the myriad of regimens outlined in research protocols and current guidelines to stimulate discussion and promote further studies pertaining to sedation strategies in TTM. Through this call to action, the ultimate goal is to develop a uniform approach to bedside practice.

Advanced Cardiac Life Support instruction in the new norm: Evaluating the hybrid versus the traditional model

Introduction: Advanced Cardiac Life Support (ACLS) course is one of the mandatory certifications for the majority of medical as well as some nursing professionals. There are, however, multiple variations in its instruction model worldwide. We aim to evaluate the efficacy of traditional ACLS course versus a hybrid ACLS course utilised during the COVID-19 pandemic. Methods: This retrospective study was carried out at SingHealth Duke-NUS Institute of Medical Simulation using course results of participants in the centre’s ACLS course between May to October 2019 for the traditional course were compared with participants attending the hybrid course from February to June 2021. Results: A total of 925 participants were recruited during the study period. Of these, 626 participants were from the traditional group and 299 participants were from the hybrid learning group. There is no statistically significant difference between the two group (χ2=1.02 p = 0.313) in terms of first pass attempts; first pass attempt at MCQ (p=0.805) and first pass attempt at practical stations (p=0.408). However, there was statistically significant difference between the mean difference in results of traditional vs hybrid MCQ score, -0.29 (95% CI: -0.57 to -0.01, p=0.0409). Finally, senior doctors were also found to perform better than junior doctors in both traditional (p=0.0235) and hybrid courses (p=0.0309) at the first pass attempt of ACLS certification. Conclusion: Participants in the hybrid ACLS course demonstrated at least equal overall proficiency in certification of ACLS as compared to the traditional instruction.

Intra‐Aortic Balloon Pump for Left Ventricular Unloading in Veno‐Arterial Extracorporeal Membrane Oxygenation: The Last Remaining Indication in Cardiogenic Shock

Intra‐Aortic Balloon Pump for Left Ventricular Unloading in Veno‐Arterial Extracorporeal Membrane Oxygenation: The Last Remaining Indication in Cardiogenic Shock