Advanced Cardiac Life Support Research Articles

REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports.MethodsThis multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events.DiscussionResults from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort.Trial registrationThe trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use.

IntroductionWhile many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care.MethodsA convenience sample of internal medicine, preliminary medicine, and transitional year residents from our large community-based tertiary care hospital participated in our survey and training. We utilized a pre-post survey method of our residents’ confidence in domains that are critical to caring for patients requiring cardiac resuscitation and stabilization. Our pre-post survey was a modified Likert scale. Our training consisted of a 1-hour faculty-led hands-on training session focused on these critical domains in our hospital’s simulation suites. Follow-up survey data were collected immediately after the training and at six and 11 months after the training using mean confidence across all five domains as the study variable.ResultsResident mean confidence in the five domains (placing leads and pads, manipulating defibrillator controls, performing defibrillation, performing synchronized cardioversion, and performing transcutaneous pacemaker use) increased immediately after our training compared to before the training (p<0.001). This increase in confidence from before the training was sustained at six and 11 months after the training (p=0.001 and p=0.002, respectively). Confidence was lower at six and 11 months than immediately after training (p=0.01 and p=0.004, respectively).ConclusionOur project showed that simulation-based training was effective in improving our trainee’s confidence in providing care to patients with life-threatening dysrhythmias. As with previous studies in simulation, confidence degradation was seen over time and likely mirrors skill degradation in these low-frequency encounters. As such, future aims include identification of ideal time intervals between training.

Assessing access to mri in patients with cardiac implantable electronic devices in australia

Abstract Funding Acknowledgements Type of funding sources: None. Background "Legacy" cardiac implantable electronic devices (CIEDs) have historically been considered non-MRI-conditional. However, a number of recent studies indicate that if certain protocols are followed, patients with such devices may undergo MRI without significant adverse outcomes. Nowadays, industry standards dictate that "modern" CIEDs are MRI compatible. Despite these developments, some patients with CIEDs are denied MRI. Paucity of access to this vital service has been shown to increase expense, lead to more invasive imaging and later diagnosis, and poorer patient outcomes. This study aims to identify if Australian public hospitals provide MRI services for patients with modern and legacy CIEDs, the characteristics of the services, and the barriers to implementing such a service. Methods This study surveyed all Australian Tertiary Referral Public Hospitals (n = 38), with a mixed qualitative and quantitative questionnaire. Results 35 of the 38 sites completed the survey. Figure 1A shows that the majority of hospitals (30/35, 85.7%) offer MRIs for modern MRI-conditional CIEDs. In contrast, Figure 1B shows that only a minority of hospitals (3/35, 8.6%) offer MRIs for legacy CIEDs. Protocols governing patient eligibility vary greatly among hospitals that scan modern devices. Locations either allow all CIEDs to be scanned, only non-dependent CIEDs, or only pacemaker CIEDs. 1.5 Tesla is the preferred strength to scan Modern CIEDs (59%), however a sizeable proportion scan at only 3.0 Tesla (10%) or both strengths (31%). A majority (80%) of staff in attendance of the scan were ACLS-trained (Advanced Cardiac Life Support), with no correlation to strength of MRI used. A range of different personnel attend the scan with varied patient monitoring strategies, and a majority (79%) offer thoracic as well as extra-thoracic scanning. The few hospitals that scan legacy devices only scan at 1.5 tesla, and follow individualised protocols. These sites offer more personnel in attendance for the scan than for modern CIED scans, with all staff ACLS-trained including a physician who can direct CIED programming of required. These sites have more involved patient monitoring, and all also offer thoracic and extra-thoracic MRI scanning. The predominant barrier identified was an absence of National Guidelines, followed by a lack of formal training or logistical device support. Conclusions The majority (85.7%) of Australian Tertiary Referral Public Hospitals have a MRI service for patients with modern CIEDs, but only 8.6% offer this service to patients with legacy CIEDs. This highlights the need for a national effort to guide the provision of MRI services for patients with CIEDs, and address the identified barriers.

Cluster Randomized Trial of Duration of Cooling in Targeted Temperature Management After Resuscitation for Cardiac Arrest.

Background: The 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend that comatose patients with return of spontaneous circulation after cardiac arrest have targeted temperature management (TTM). However, the duration of TTM remains to be elucidated.Methods and Results: We conducted a cluster randomized trial in 10 hospitals to compare 12–24 vs. 36 h of cooling in patients with cardiac arrest who received TTM. The primary outcome was the incidence, within 1 month, of complications including bleeding requiring transfusion, infection, arrhythmias, decreasing blood pressure, shivering, convulsions, and major adverse cardiovascular events. Secondary outcomes were mortality and favorable neurological outcome (Cerebral Performance Categories 1–2) at 3 months. Random-effects models with clustered effects were used to calculate risk ratios (RR). Data of 185 patients were analyzed (12- to 24-h group, n=100 in 5 hospitals; 36-h group, n=85 in 5 hospitals). The incidence of complications within 1 month did not differ between the 2 groups (40% vs. 34%; RR 1.04, 95% confidence interval [CI] 0.67–1.61, P=0.860). Favorable neurological outcomes at 3 months were comparable between the 2 groups (64% vs. 62%; RR 0.91, 95% CI 0.72–1.14, P=0.387).Conclusions: TTM at 34℃ for 12–24 h did not significantly reduce the incidence of complications. This study did not show superiority of TTM at 34℃ for 12–24 h for neurologic outcomes.

Assessment of chest compression interruptions during advanced cardiac life support

AimTo identify potentially avoidable factors responsible for chest compression interruptions and to evaluate the influence of chest compression fraction on achieving return of spontaneous circulation and survival to hospital discharge. MethodsIn this prospective observational study, each resuscitation managed by mobile medical teams from August 1st, 2016, to August 1st, 2018 was video recorded using a body-mounted GoPro camera. The duration of all chest compression interruptions was recorded and chest compression fraction was calculated. All actions causing an interruption of at least 10 s were analyzed. ResultsTwo hundred and six resuscitations of both in- and out-of-hospital cardiac arrest patients were analysed. In total 1867 chest compression interruptions were identified. Of these, 623 were longer than 10 s in which a total of 794 actions were performed. In 4.3% of the registered pauses, cardiopulmonary resuscitation was interrupted for more than 60 s. The most performed actions during prolonged interruptions were rhythm/pulse checks (51.6%), installation/use of mechanical chest compression devices (11.1%), cardiopulmonary resuscitation provider switches (6.7%) and ETT placements (6.2%). No statistically significant relationship was found between chest compression fraction and return of spontaneous circulation or survival. ConclusionThe majority of chest compression interruptions during resuscitation were caused by prolonged rhythm checks, cardiopulmonary resuscitation provider switches, incorrect use of mechanical chest compression devices and ETT placement. No association was found between chest compression fraction and return of spontaneous circulation, nor an influence on survival. This was presumably caused by the high baseline chest compression fraction of >86%.

Comparison the impact of face-to-face training package for resuscitation with presentation by messaging software on emergency medicine rotation interns

Introduction: Conventional approaches in advanced cardiac life support (ACLS) are used, including; lectures, video presentations, practical educations on moulage, also employing messenger applications can potentially be regarded as a method to train interns. Objectives: The current study aims to compare two methods of face-to-face and virtual training by WhatsApp messenger, regarding the impact of training on interns’ knowledge and satisfaction for advanced cardio resuscitation rotational interns in emergency medicine. Patients and Methods: In this cross-sectional study, 73 rotation interns of emergency medicine of Tehran University of Medical Sciences from 2017 to 2018 were divided into two groups: 1) face-to-face training, 2) virtual training by using WhatsApp messenger application. Initially, a pretest of 10 questions about main topics in advanced cardiac support was conducted on interns. At the end of training course, a posttest of 20 questions was conducted for both groups. Results: Mean value of pretest was 6.46 for face-to-face training group and 5.97 for WhatsApp group (P=0.29). Posttest mean score was 14.08 for face-to-face group and 12.03 for WhatsApp (P=0.003). Interns’ satisfaction scores were 7.68 and 7.36 for face-to-face and WhatsApp group respectively (P=0.25). Mean scores of pretest and posttest within group had no significant differences between groups, but Cohen’s effect size for face-to-face group was greater than WhatsApp trained group. Conclusion: Face-to-face training was associated with better results in promoting knowledge of interns, compared to WhatsApp training. That’s advisable to employ face-to-face training for interns.

Hyperkalemic circulatory shock and cardiac arrest altered by therapeutic management: A case report

Hyperkalemia is one of the few potentially lethal electrolyte disturbances. Severe hyperkalemia (Serum potassium concentration &gt; 6.5 mmol/L) occurs most commonly from renal failure or the release of potassium from cells and can cause circulatory shock, cardiac arrhythmias or cardiac arrest. Current BLS (Basic Life Support) and ACLS (Advanced Cardiovascular Life Support) protocol should be used to manage cardiac arrest associated with hyperkalemia. But early consideration should be given to using the selective method of therapeutic management in addition to standard ACLS protocols that can be provided rapidly, effectively in patients with cardiovascular instability. We describe here a case of chronic kidney disease and congestive heart failure who developed circulatory shock and eventually cardiac arrest due to hyperkalemia managed with Calcium Gluconate, Sodium Bicarbonate and Insulin along with standard advanced cardiovascular life support protocol. Keywords: Potassium, hyperkalemia, acidosis, calcium, insulin, cardiac arrest.

Impact of COVID-19-adapted guidelines on resuscitation quality in out-of-hospital-cardiac-arrest: a manikin study.

The aim of this study is to evaluate the effects of European Resuscitation Council (ERC) COVID-19-guidelines on resuscitation quality emphasizing advanced airway management in out-of-hospital-cardiac-arrest. In a manikin study paramedics and emergency physicians performed advanced cardiac life support in three settings: ERC guidelines 2015 (control), COVID-19-guidelines as suggested with minimum staff (COVID-19-minimal-personnel); COVID-19-guidelines with paramedics and an emergency physician (COVID-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean±standard deviation. Thirty resuscitation scenarios were completed. No-flow-time was markedly prolonged in COVID-19-minimal-personnel (113±37 s) compared to control (55±9 s) and COVID-19-advanced-airway-manager (76±38s; P<0.001 each). In both COVID-19-groups chest compressions started later (COVID-19-minimal-personnel: 32±6 s; COVID-19-advanced-airway-manager: 37±7 s; each P<0.001 vs. control [21±5 s]), but oxygen supply (COVID-19-minimal-personnel: 29±5 s; COVID-19-advanced-airway-manager: 34±7 s; each P<0.001 vs. control [77±19 s]) and first intubation attempt (COVID-19-minimal-personnel: 111±14 s; COVID-19-advanced-airway-manager: 131±20 s; each P<0.001 vs. control [178±44 s]) were performed earlier. However, time interval to successful intubation was similar (control: 198±48 s; COVID-19-minimal-personnel: 181±42 s; COVID-19-advanced-airway-manager: 130±25 s) due to a longer intubation time in COVID-19-minimal-personnel (61±35 s) compared to COVID-19-advanced-airway-manager (P=0.002) and control (19±6 s; P<0.001). Time to first rhythm analysis was more than doubled in COVID-19-minimal-personnel (138±96 s) compared to control (50±12 s; P<0.001). Delayed chest compressions and prolonged no-flow-time markedly reduced the quality of resuscitation. These negative effects were attenuated by increasing the number of staff and by adding an experienced airway manager. The use of endotracheal intubation for reducing aerosol release during resuscitation should be discussed critically as its priorization is associated with an increase in no-flow-time.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Resuscitation in Community Healthcare Facilities in Israel.

Background: Out-of-hospital cardiac-arrest (OHCA) is a major public health challenge. Community health care providers (CHP) may play an important role through early identification, basic life support and defibrillation. Few studies have evaluated the incidence and characteristics of OHCAs initially cared for by CHP, most finding improved survival. This study combined CHP treated OHCA case analysis, with assessment of provider resuscitation preparedness. Methods: An analysis of all CHP initiated resuscitations in a large Health Maintenance Organization (HMO) reported over 42 months, coupled with an online survey assessing CHP resuscitation knowledge, experience, training and self-confidence. Results: 22 resuscitations met inclusion criteria. In 21 CHP initiated chest-compressions but in only 8 cases they utilized the clinic’s automated external defibrillator (AED) prior to emergency medical services (EMS) arrival. There were 275 providers surveyed. Of the surveyed providers, 89.4% reported previous basic life support (BLS)/advanced cardiovascular life support (ALS) training, 67.9% within the last three years. Previous resuscitation experience was reported by 72.7%. The lowest scoring knowledge question was on indications for AED application −56.3%. Additionally, 44.4% reported low confidence in their resuscitation skills. CHP with previous cardiopulmonary resuscitation (CPR) experience reported higher confidence. Longer time since last CPR training lowered self-confidence. Conclusions: Early AED application is crucial for patients with OHCA. All clinics in our study were equipped with AED’s and most CHP received training in their use, but remained insecure regarding their use, often failing to do so.

Fatal Case of Dysphagia Induced by Neurofibromatosis Type II

A 17-year-old boy was found in an unconscious state. He had had neurofibromatosis type 2 (NF2) since 9 years old. His history included multiple operations for NF2 at the left jugular vein foramen, thoracic spinal cord, and cervical spinal cord at 9 and 10 years old. However, remaining bilateral acoustic tumors resulted in the onset of aspirated pneumonia within a few months. He was found unconscious in his dormitory. When emergency medical technicians checked him, he was in cardiac arrest. Saburra was identified in his mouth. He did not achieve return of spontaneous circulation with advanced cardiac life support. Autopsy imaging revealed residual bilateral acoustic tumors compressing the brain stem. NF2 is a serious disease that can rapidly become life-threatening. We hope new treatments that will improve the survival of NF2 patients will be developed soon.

Trends in Endotracheal Intubation During In-Hospital Cardiac Arrests: 2001-2018.

Airway management during in-hospital cardiac arrest represents a fundamental component of resuscitative efforts, yet little is known about temporal trends in intubation during in-hospital cardiac arrest. Our objective was to investigate changes in in-hospital cardiac arrest airway management over time and in response to national guideline updates. Observational cohort study of a prospectively collected database. Multicenter study of hospitals participating in the "Get With The Guidelines-Resuscitation" registry from January 1, 2001, to December 31, 2018. Adult patients who experienced an in-hospital cardiac arrest and did not have an invasive airway in place prior to the arrest. The primary outcome was the rate of intra-arrest intubation from 2001 to 2018. We constructed multivariable regression models with generalized estimating equations to determine the annual adjusted odds of intubation. We also assessed the timing of intubation relative to the onset of pulselessness and other arrest measures. We used an interrupted time-series analysis to assess the association between the 2010 Advanced Cardiac Life Support guideline update and intubation rates. One thousand sixty-six eight hundred patients from 797 hospitals were included. From 2001 to 2018, the percentage of patients intubated during an arrest decreased from 69% to 55% for all rhythms, 73% to 60% for nonshockable rhythms, and 58% to 36% for shockable rhythms (p < 0.001 for trend for all 3 groups). The median time from onset of pulselessness to intubation increased from 5 minutes in 2001 (interquartile range, 2-8 min) to 6 minutes in 2018 (interquartile range, 4-10 min) (p < 0.001 for trend). Following the 2010 guideline update, there was a downward step change and a steeper decrease over time in the rate of intubation as compared to the preintervention period (p < 0.001). Endotracheal intubation rates during in-hospital cardiac arrest have decreased significantly over time, with a more substantial decline following the updated 2010 guideline that prioritized chest compressions over airway management.

Improved Physician Understanding of Patient End-of-Life Preferences: A Quality Improvement Project

BackgroundCode status (CS) orders lack a universal definition. We aimed to improve provider understanding of order options. MeasuresProvider's knowledge of CS terminology, ease of understanding CS orders and ease of starting CS discussions. InterventionA multifaceted intervention including 1) altered CS order language in the electronic medical record (EMR) from “Full Interventions,” “Limited Interventions,” and “Comfort Measures Only” to “Full advanced cardiovascular life support (ACLS),” “Partial ACLS,” and “No ACLS” 2) clinical tools for CS identification 3) provider education. OutcomesCorrect provider response rate for “Partial ACLS” and “No ACLS” terms increased from 43.5 to 60% and 20 to 71% (odds ratio 1.95; 95% confidence interval 0.99–3.83; P = 0.03, OR 9.8; CI 4.48–21.49; P < 0.001). The proportion of providers who felt understanding CS orders and starting conversations about CS was “very easy” (a score of 1–3 on a scale of 1 to 10) improved from 26.1 to 45.7% (P = 0.01) and 49.3 to 65.7% (P = 0.03). Conclusions/Lessons LearnedProvider understanding of CS options can be improved with a combined QI intervention.

The Impact of Cardiopulmonary Resuscitation Guidelines Updates Against Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study

Background: International cardiopulmonary resuscitation (CPR) guidelines based on the best available evidence from resuscitation science have been updated since 2000. However, few nationwide population-based studies have been investigated comprehensive efficacy of those updates for out-of-hospital cardiac arrest (OHCA). Methods: From the All-Japan Utstein Registry between 2005 and 2015, we enrolled 73 578 adults who had witnessed shockable (ventricular fibrillation or pulseless ventricular tachycardia) OHCA. We examined temporal trends over eleven years (2005 on the Guidelines 2000 era, from 2006 to 2010 on the consensus on CPR and emergency cardiovascular care science with treatment recommendations [CoSTR] 2005 era, and from 2011 to 2015 on the CoSTR 2010 era). The primary end point was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. Findings: Of 73 578 study patients, 61,080 (83%) were witnessed by bystander and 12 498 (17%) by emergency medical services (EMS) responder. After adjustment for Utstein variables, odds ratios for favorable 30-day neurological outcome increased year by year (reference, 2005): the bystander-witnessed group, 1∙19 (95% CI 1∙03-1∙37) in 2006, 2∙40 (95% CI 2∙10-2∙74) in 2010, 2∙45 (95% CI 2∙14-2∙80) in 2011 and 3∙02 (95% CI 2∙63-3∙46) in 2015; the EMS responder-witnessed group, 1∙27 (95% CI 1∙01-1∙60) in 2007, 1∙28 (95% CI 1∙02-1∙60) in 2010, 1∙54 (95% CI 1∙23-1∙94) in 2011 and 1∙58 (95% CI 1∙26-1∙99) in 2015. Similar results were seen in the subgroups receiving EMS-dispatcher CPR instruction, bystander chest compression-only CPR, early defibrillation, biphasic waveform defibrillators or advanced airway management. However, there was no evidence for any benefit from the addition of epinephrine. Interpretation: The international CPR guidelines updates for shockable OHCA had improved neurologically intact survival year by year. However, epinephrine is a topic for the future. Clinical Trial Registration Details: This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMI09918. Funding Information: None. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: A subcommittee of resuscitation science in the Japanese Circulation Society conducted this study with approval from the ethics committee at Nihon University Hospital.

Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury.&#x0D; Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion.&#x0D; Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial.

BackgroundPrehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation.MethodsA prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult).ResultsThe first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p<0.001), 43 ± 7 s for Jamshidi (p<0.001), and 98.5 ± 10 s for IV access (p<0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p=1.0) compared with Jamshidi (5 ± 3 points; p<0.001) and IV access (7 ± 2 points; p<0.001).ConclusionThe study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

Evaluating the effectiveness of interprofessional advanced cardiac life support training: a sequential mixed-methods approach

ABSTRACT Interprofessional advanced cardiac life support (IP-ACLS) training is a holistic learning experience; thus, our research team incorporated this training into an undergraduate programme. Considering that IP-ACLS training is a new paradigm in nursing education, evaluating its effectiveness is essential. This research aimed to (1) evaluate the effectiveness of this training on improving the perceived level of interprofessional collaboration, self-efficacy and emotion regulation and (2) explore the learning experience of nursing students during training. The study design adopted a sequential mixed-method approach comprising a two-group pretest and posttest design amongst 120 students, followed by nine focus group discussions. Quantitative results demonstrated significant improvements in the perceived level of interprofessional collaboration, self-efficacy and emotion regulation at post-intervention and follow-up. Qualitative data were collected through video recording and field notes. Thematic analysis was performed following the method of Braun and Clarke. Qualitative analysis of focus group transcripts identified three themes: synergistic partnership, clinical readiness and improving further training. Quantitative and qualitative results were integrated in accordance with the mixed data analysis framework. These results complemented one another. The training provided an authentic learning experience and a good steppingstone to nursing students who are preparing to work interprofessionally in the future.

Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study

Detecting the presence of a pulse is pivotal to initiating and guiding cardiopulmonary resuscitation (CPR). Palpating the carotid or femoral artery pulse are historically the most common areas providers assess during a resuscitation. Unfortunately manual palpation of a pulse is operator dependent and varies based on patient anatomical differences and vital signs. The Advanced Cardiac Life Support (ACLS) guidelines defined by the American Heart Association (AHA) states that pulse checks should be accomplished quickly to minimize time between chest compressions in CPR.

Cutaneous Complications Associated With Intraosseous Access Placement.

Intraosseous (IO) access provides a potentially lifesaving means of vascular access in settings of trauma and advanced cardiovascular life support in which patients often require prompt and large volumes of fluid resuscitation, blood products, and medications. An additional benefit of IO access is the rare incidence of complications, with many studies reporting rates of less than 1%. The most commonly cited complications include compartment syndrome, osteomyelitis, traumatic bone fracture, and epiphyseal plate damage. To evaluate the dermatologic sequelae, we performed a retrospective chart review spanning 18 consecutive months to identify patients who underwent IO line placement, either at or en route to a large metropolitan level I trauma center in the Midwestern United States. Our review identified a complication rate of 2.7%, with complications including compartment syndrome, needle breakage, and a previously unreported cutaneous complication of traumatic bullae.

AHA update: BLS, ACLS, and PALS.

The American Heart Association (AHA) recently released its 2020 guidelines for advanced cardiovascular life support, basic life support, and pediatric advanced life support. This article details these updates, as well as the latest AHA recommendations for CPR and emergency cardiovascular care.