Advanced Cardiopulmonary Resuscitation Research Articles

Survival after receiving advanced cardiopulmonary resuscitation and associated factors in children over 1 month in a hospital in Mexico

Survival after receiving advanced cardiopulmonary resuscitation and associated factors in children over 1 month in a hospital in Mexico

Development and effects of advanced cardiac resuscitation nursing education program using web-based serious game: application of the IPO model

BackgroundThe significant rise in cardiac arrest cases within hospitals, coupled with a low survival rate, poses a critical health issue. And in most situations, nurses are the first responders. To develop nursing students’ competencies in advanced cardiopulmonary resuscitation, systematic and repetitive learner-centered self-directed education that can promote the integration of knowledge and practice is necessary.ObjectivesTo develop an advanced cardiopulmonary resuscitation training program using a web-based serious game for nursing students and verifying its efficacy.DesignThe program was developed based on the stages of analysis, design, development, implementation, and evaluation, and the Input Process Outcome Model of Serious Game Design formed the theoretical basis.Settings and participantsThe research design employed a before-and-after non-equivalent control group, and data collection took place among 2nd and 3rd year nursing students at K University in D City, Korea, from March 2, 2023, to March 24, 2023.MethodsThe program consisted of a 120-min video lecture, 30 min of a web-based serious game, 30-min of written self-reported debriefing, and individual feedback using a video conference system. The effectiveness of the program was measured for both groups using an 89-item structured questionnaire regarding knowledge, confidence in performance, problem-solving ability, and learning transfer expectations.ResultsThe program was effective in improving nursing students’ advanced cardiopulmonary knowledge, confidence in performance, problem-solving ability, and learning transfer expectation immediately after intervention.ConclusionsThis program underscores the necessity of a new direction in nursing education, emphasizing learner-centered approaches, rather than the traditional focus on the mere transmission of basic knowledge and skills, to cultivate nurses with advanced cardiopulmonary resuscitation capabilities.

Parada cardiorrespiratoria intradiálisis y anafilaxia a membrana de dializador como probable etiología en un paciente con inicio de terapia sustitutiva renal por enfermedad renal crónica.

Introduction: During the dialysis session, hypersensitivity reactions to the dialyzer may occur. Clinically, these conditions can vary in severity, from pruritus, erythema, and facial edema to more severe conditions such as dyspnea, bronchospasm, tachypnea, cyanosis, shock, and cardiac arrest. We present an unusual case of repeated anaphylactic shock, possibly caused by the use of a dialyzer with a helixone membrane. Clinical case: 60-year-old hypertensive and type 2 diabetic woman who presented uremia with hypervolemia and underwent dialysis treatment in the hemodialysis program. During the sixth session, she witnessed cardiorespiratory arrest, with recovery of spontaneous circulation after advanced cardiopulmonary resuscitation. Management: Required management in intensive care with intravenous nitroprusside and intubation with mechanical ventilation. Evolution: Given a new treatment, he once again developed hemodynamic instability with hypotension at the beginning of treatment. She was transferred to the peritoneal dialysis program. Conclusion: An anaphylactic reaction to helixone associated with hypotension and anaphylactic shock is reported.

Evolution of the use of intraosseous vascular access in prehospital advanced cardiopulmonary resuscitation: The IOVA-CPR study.

Obtaining vascular access is crucial in critically ill patients. The EZ-IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased. We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation. Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation. Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001. The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.

Knowledge and attitudes of physicians in Chile toward Do-Not-Attempt-Resuscitation orders: A cross-sectional nation-wide study.

Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic efforts in cases where it may be futile. The decision not to resuscitate a patient is a process that involves a series of ethical, legal, and clinical considerations. Still, it also requires a process in which priority is given to the patients and their autonomy. The objective of this study was to describe the knowledge and attitudes of physicians working in Chile toward Do-Not-Attempt-Resuscitation orders. A cross-sectional study was conducted, in which a digital questionnaire was sent to physicians from different regions of Chile. Quantitative variables were analyzed using measures of central tendency and dispersion (e.g., median and interquartile range), while qualitative variables were evaluated using frequencies and percentages. Four hundred and thirty-one physicians completed the survey. 85.4% were familiar with the ethical and legal guidelines for cardiopulmonary resuscitation and the rights and duties of the patient. 39.2% believed that patients should have the final decision Do-Not-Attempt-Resuscitation orders, especially if they themselves requested not to be resuscitated. 87.7% mentioned that the Do-Not-Attempt-Resuscitation orders should be reassessed if the patient's prognosis improves. In addition, it was found that the decision not to resuscitate was not always discussed with the patient or their family. The study revealed an ethical conflict regarding Do-Not-Attempt-Resuscitation orders and their management by Chilean physicians. Therefore, it is necessary to create recommendations and provide training to guide professionals in this process, which should also involve patients and their families.

Enriching nursing knowledge and practice in Jordanian government hospitals through basic life support simulation training: A randomized controlled trial.

Healthcare providers must possess the necessary knowledge and skills to perform effective cardiopulmonary resuscitation (CPR). In the event of cardiopulmonary arrest, basic life support (BLS) is the initial step in the life-saving process before the advanced CPR team arrives. BLS simulation training using manikins has become an essential teaching methodology in nursing education, enhancing newly employed nurses' knowledge and skills and empowering them to provide adequate resuscitation. This study aimed to evaluate the potential effect of BLS simulation training on knowledge and practice scores among newly employed nurses in Jordanian government hospitals. A total of 102 newly employed nurses were randomly assigned to two groups: the control group (n = 51) received standard training, and the experimental group (n = 51) received one full day of BLS simulation training. The training program used the American Heart Association (AHA)-BLS-2020 guidelines and integrated theoretical models such as Miller's Pyramid and Kolb's Cycle. Both groups were homogeneous in inclusion characteristics and pretest results. Knowledge and practice scores were assessed using 23 multiple-choice questions (MCQs). Data were analyzed using one-way repeated measures ANOVA. The results indicated significant differences in knowledge scores, F(2, 182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001, between the control and experimental groups at all measurement times: pretest, posttest 1, and posttest 2. Moreover, Cohen's d reflected the effectiveness of BLS simulation training as an educational module, showing a large effect (Cohen's d = 1.568) on participants' knowledge levels and a medium effect (Cohen's d = 0.749) on participants' practice levels. The study concludes that BLS simulation training using the AHA-BLS-2020 guidelines and integrating theoretical models such as Miller's Pyramid and Kolb's Cycle significantly improves knowledge and practice scores among newly employed nurses, proving highly effective in enhancing their competencies in performing CPR. Implementing BLS simulation training in nursing education programs can significantly elevate the proficiency of newly employed nurses, ultimately improving patient outcomes during cardiopulmonary arrest situations. This training approach should be integrated into standard nursing curricula to ensure nurses are well-prepared for real-life emergencies. NCT06001879.

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

AimBag-mask ventilation (BMV) is often applied during advanced cardiopulmonary resuscitation (CPR). Lay rescuers usually apply mouth-to-mouth ventilation, which is contraindicated in case of potential disease transmission (e.g., during the COVID-19 pandemic). This study evaluates the influence of rescuers' before BMV training in following the correct BMV procedures during adult and infant CPR.MethodsMedical students (n = 112) were enrolled in a randomized cross-over manikin study: 60 first-year students (53.6%) (untrained, without any prior knowledge of CPR) and 52 fourth-year students (46.4%) (BLS-trained, with three consecutive years of basic CPR training), excluding Basic Life Support (BLS) certificate holders or lifeguards. Student-formed duos (i.e., two students from the same year working together) received a 15-min just-in-time onsite training in full CPR cycle using BMV and were tested during five cycles of 2-person CPR following the European Resuscitation Council (ERC) guidelines with the inclusion of BMV. Tidal volumes of 300–600 ml (adults) and 20–60 ml (infants) were considered as correct ventilations.ResultsFrom the initial 56 duos, 17 (30.4%) were excluded after applying incorrect numbers of ventilation or uninterpretable values. In adult CPR, comparing BLS-trained rescuers to untrained ones in correctly administrating ventilations using BMV after a 15-min just-in-time onsite training revealed no statistically significant difference [first years: 63.0% (n = 136 out of 216 ventilations); fourth years: 59.5% (n = 119 out of 200 ventilations); with a proportional difference of −3.5% (−12.8; 5.9)]. In infant CPR, a significant difference was observed in effective ventilations [first years: 55.5% (n = 120 out of 216 ventilations); fourth years: 72.3% (n = 133 out of 184 ventilations); with a proportional difference of 16.8 (7.25; 26.21)].ConclusionTwo-person BMV is a complex skill to perform both in adults and children, requiring sufficient and regular training. Lay rescuers receiving a 15-min just-in-time onsite BMV training could perform decent BMV in an adult CPR setting. BMV during infant CPR requires more extensive prior training and should not be entrusted to lay rescuers, even after a 15-min just-in-time onsite training.

Validation of the knowledge evaluation questionnaire of the cardiopulmonary resuscitation training program in high school students.

There is an urgent need for generalized training in cardiopulmonary resuscitation (CPR) techniques, starting with secondary education. Validated instruments for assessing the efficacy of such interventions are not yet available. This study aimed to validate an evaluation questionnaire of a CPR training program for high school students, to analyze the levels of readability, difficulty, reliability, and content validity, as well as the fit the purpose for which they were designed, the trait they are intended to measure. An instrumental study was conducted in 2 phases. In the first phase, an inter-judge validation was carried out with 11 experts in CPR accredited instructors of basic and advanced CPR by the American Heart Association. In the second phase, the psychometric properties were evaluated from the perspective of Item Response Theory. During May of the 2017/18 and 2018/19 academic years, 259 4th-year secondary school students from a high school in the southeastern area of the island of Gran Canaria (mean age: 15.78 years; 50.60% male) were surveyed anonymously using the questionnaire to be validated. The questionnaire was easily readable (74.12 Flesch-Szigriszt Index); the difficulty level (Easy/Very Easy) in the context of this secondary school level of education and the ability level of the respondents overlapped sufficiently and there was no gender bias. The questionnaire was able to discriminate between respondents of slightly more than 7 levels of expertise, from low knowledge of CPR to high knowledge of CPR (Separation Index 7.53). The model fit was excellent (infit = 1/outfit = 1.01). The content validity index was adequate. The separation index and reliability exceeded what was considered adequate for guaranteed use. The level of difficulty of the items and the level of ability of the respondents is in line with the educational level of the students. The questionnaire did not produce a gender bias in response probability. The questionnaire is easily understandable and can discriminate between different levels of ability without differential gender bias, and its reliability is outstanding, as it exceeds the minimum criteria.

General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest.

Cardiac arrest affects millions of people per year worldwide. Although advances in cardiopulmonary resuscitation and intensive care have improved outcomes over time, neurologic impairment and multiple organ dysfunction continue to be associated with a high mortality rate. The pathophysiologic mechanisms underlying the post-resuscitation disease are complex, and a coordinated, evidence-based approach to post-resuscitation care has significant potential to improve survival. Critical care management of patients resuscitated from cardiac arrest focuses on the identification and treatment of the underlying cause(s), hemodynamic and respiratory support, organ protection, and active temperature control. This review provides a state-of-the-art appraisal of critical care management of the post-cardiac arrest patient.

Influence of donor capnometry on renal graft evolution in uncontrolled donation after circulatory death

AimTo analyse the association between donor capnometry data and the short-term evolution of kidney grafts in cases of uncontrolled donation after circulatory death (uDCD). MethodWe used an ambispective observational study design, conducted in the Community of Madrid between January and December 2019, inclusive. Patients who suffered out-of-hospital cardiac arrest (CA) with no response to advanced cardiopulmonary resuscitation (CPR) were selected as potential donors. Donor capnometry levels were measured at the start, midpoint and transfer to hospital then compared with indicators of renal graft evolution. ResultsThe initial selection included 34 possible donors, of which 12 (35.2%) were viable donors from whom 22 (32.3%) kidneys were recovered. There was a correlation between the highest capnometry values and less need for post-transplant dialysis (≥24 mmHg, p < 0.017), fewer dialysis sessions and fewer days to recover correct renal function (Rho −0.47, p < 0.044). There was a significant inverse correlation between the capnometry values at transfer and 1-month post-transplant creatinine levels (Rho −0.62, p < 0.033). There were no significant differences between the capnometry values at transfer and primary nonfunction (PNF) or warm ischaemia time. One-year patient survival was 100% for patient receiving organ donation, while graft survival was 95%. ConclusionsCapnometry levels at transfer are a useful predictor of the short-term function and viability of kidney transplants from uncontrolled donations after circulatory death.

Sudden death in sports. 2018-2020. Argentine Registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The prevalence of Sudden Death in Sports (SDS) is low in relation to other forms of death in the general population. There is little current data about this problem in Argentina. Objectives Obtain information about the characteristics of these events in order to recommend effective prevention measures. Methods A specific mailbox was created to receive SDS case reports. The study was presented in academic, health and social media institutions. The information received was analyzed and investigated with direct contact with professionals or people related to the event. Results From January 2018 to February 2020, 26 months, 35 cases of SDS were surveyed. 89% of the male sex pts, 68% over 35 years. SDS occurred mainly in: Football, 11 pts, Gymnastics, 10 pts and marathon 9 pts. 68% of the athletes were amateurs and 52% during high performance practices. Assistance received: 29 athletes received assistance, 19 pts Basic Cardiopulmonary Resuscitation (CPR) and 10 pts advanced CPR with automatic or manual defibrillation in 9 cases. Of the 21 pts that were transferred, 9 pts entered and 8 exited alive. The survival rate was 23% and all graduated in functional class I. A forensic autopsy was performed in only 8 cases. Associated pathologies: 8 pts with coronary heart disease, 7 pts dilated cardiomyopathy, 3 pts, unspecified heart disease, 1 pt with toxic medication, 1 pt died from commotio cordis and 15 pts without diagnosis. Conclusions The number of reported cases of SDS was low, with an approximate incidence of 0.25% / 100,000.hab / year, 1 to 2 cases per month. SDS episodes occurred mainly in football, gymnasia and marathon, with an adequate level of on-site assistance and greater use of defibrillation therapy compared to previous reports. High mortality persists (77%). The use of autopsy is low showing cardiomyopathy or unknown origin in young people and coronary disease in adults

Optimal oxygen use in neonatal advanced cardiopulmonary resuscitation-a literature review.

Oxygen (O2) use during neonatal cardiopulmonary resuscitation (CPR) remains a subject of controversy. The inspired O2 concentration during neonatal CPR, that hastens return of spontaneous circulation (ROSC), allows adequate cerebral and myocardial O2 delivery, and enhances survival to discharge, is not known. The optimal FiO2 during CPR should decrease incidence of hypoxia but also avoid hyperoxia, and ultimately lead to improved neurodevelopmental outcomes. Due to infrequent need for extensive resuscitation, and emergent circumstances surrounding neonatal CPR, conducting randomized clinical trials continues to be a challenge. The goal of this study was to review the evolution of oxygen use during neonatal CPR, the evidence from animal and clinical studies on oxygen use during neonatal CPR and after ROSC, the pertinent physiology including myocardial oxygen consumption and cerebral oxygen delivery during CPR, and outcomes following CPR in the DR and in the neonatal intensive care unit. This narrative review is based on recent and historic English literature in PubMed and Google scholar over the past 35 years (January 1, 1985 - May 1, 2021). Several studies in animal models have compared ventilation with different inspired O2 concentrations (mostly 21% and 100%) during chest compressions and after ROSC. These studies reported no difference in short-term outcomes, even with as low as 18% O2. However, in lamb models of cardiac arrest and CPR, 100% O2 during chest compressions is associated with better oxygen delivery to the brain compared to 21% O2. Abrupt weaning to 21% O2 following ROSC followed by titration to achieve preductal SpO2 of 85-95% minimizes systemic hyperoxia and oxidative stress compared to slow weaning from 100% O2 following ROSC. Clinical research is needed to arrive at the best strategy for assessment of oxygenation and choice of FiO2 during neonatal CPR that lead to improved survival and outcomes. In this article, we have reviewed the literature on evidence behind O2 use during neonatal advanced CPR and after ROSC.

Sustained Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest; Developing a Predictive Model Based on Multivariate Analysis.

Identifying the predictive factors of sustained return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) will be helpful in management of these patients. This study aimed to develop a predictive model in this regard. In a retrospective observational study, data of adult patients with OHCA, were collected from Vajira emergency medical services patient care report. Multiple logistic regression analysis with a regression coefficient was used to develop a predictive score for a sustained ROSC at the scene. Area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the accuracy of the predictive score for a sustained ROSC. Independent factors associated with a sustained ROSC included cardiopulmonary resuscitation (CPR) duration < 30 min (adjusted odds ratio (AOR)= 5.05, 95% confidence interval (CI): 3.34-7.65; p < 0.001); advanced airway management with an endotrachealtube (AOR= 3.06, 95% CI: 1.77-5.31; p < 0.001); advanced airway management with laryngeal mask airway (AOR= 3.42, 95% CI: 1.02-11.46; p = 0.046); defibrillation (AOR = 2.05, 95% CI: 1.31-3.2; p = 0.002); Capillary blood glucose (CBG) level < 150 mg% (AOR= 1.95, 95% CI: 1.05-3.65; p = 0.035); CBG at least 150 mg% (AOR= 2.87, 95% CI: 1.56-5.29; p = 0.001); pupil reflex (AOR = 2.96, 95% CI: 1.1-7.96; p = 0.032); and response time at most 8 min (AOR= 1.66, 95% CI: 1.07-2.57; p = 0.023). These were developed into the pupil reflex, response time, advanced airway management, defibrillation, CBG, and CPR duration (PRAD-CCPR) score. The most accurate cutoff point of score using Youden's index was ≥ 6 with AUC of 0.759 (95% CI: 0.715-0.802; p < 0.001), sensitivity of 62.0% (95% CI: 51.2-71.9%), specificity of 75.7% (95% CI: 69.4-81.2%), positive predictive value of 51.8% (95% CI: 40.9-62.3%), and negative predictive value of 79.5% (95% CI: 73.5-84.6%). An optimal PRAD-CCPR score of ≥ 6 provides an acceptable accuracy of 0.759 with sensitivity of 62.0% and specificity of 75.7% in prediction of sustained ROSC following OHCA. This predictive score might help CPR commanders to prognosticate the outcome of patients with OHCA at the scene.

Comparison of Two Methods of Face-To-Face Training and Virtual Training in Learning Advanced Cardiopulmonary Resuscitation Concepts among Emergency Department Interns

Comparison of Two Methods of Face-To-Face Training and Virtual Training in Learning Advanced Cardiopulmonary Resuscitation Concepts among Emergency Department Interns

Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable?

BackgroundAnticipating the need for at-birth cardiopulmonary resuscitation (CPR) in neonates is very important and complex. Timely identification and rapid CPR for neonates in the delivery room significantly reduce mortality and other neurological disabilities. The aim of this study was to create a prediction system for identifying the need for at-birth CPR in neonates based on Machine Learning (ML) algorithms.MethodsIn this study, 3,882 neonatal medical records were retrospectively reviewed. A total of 60 risk factors was extracted, and five ML algorithms of J48, Naïve Bayesian, multilayer perceptron, support vector machine (SVM), and random forest were compared to predict the need for at-birth CPR in neonates. Two types of resuscitation were considered: basic and advanced CPR. Using five feature selection algorithms, features were ranked based on importance, and important risk factors were identified using the ML algorithms.ResultsTo predict the need for at-birth CPR in neonates, SVM using all risk factors reached 88.43% accuracy and F-measure of 88.4%, while J48 using only the four first important features reached 90.89% accuracy and F-measure of 90.9%. The most important risk factors were gestational age, delivery type, presentation, and mother’s addiction.ConclusionsThe proposed system can be useful in predicting the need for CPR in neonates in the delivery room.

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death.

Background.Due to organ shortage, many patients do not receive donor organs. The present novel thrombolytic technique utilizes organs from donors with uncontrolled donation after circulatory deaths (uDCD), with up to 4–5 h warm ischemia, without advanced cardiopulmonary resuscitation (aCPR) or extracorporeal circulation (EC) after death.Methods.The study group of pigs (n = 21) underwent simulated circulatory death. After 2 h, an ice slush was inserted into the abdomen. Kidneys were retrieved 4.5 h after death. Lys-plasminogen, antithrombin-III (ATIII), and alteplase (tPA) were injected through the renal arteries on the back table. Subsequent ex vivo perfusion at 15 °C was continued for 3 h, followed by 3 h with red blood cells (RBCs) at 32 °C. Perfusion outcome and histology were compared between uDCD kidneys, receiving no thrombolytic treatment (n = 8), and live donor kidneys (n = 7). The study kidneys were then transplanted into pigs as autologous grafts with a single functioning autologous kidney as the only renal support. uDCD control pigs (n = 8), receiving no ex vivo perfusion, served as controls.Results.Vascular resistance decreased to <200 mmHg/mL/min (P < 0.0023) and arterial flow increased to >100 mL/100 g/min (P < 0.00019) compared to controls. In total 13/21 study pigs survived for >10 days, while all uDCD control pigs died. Histology was preserved after reconditioning, and the creatinine level after 10 days was next to normal.Conclusions.Kidneys from extended uDCD, not receiving aCPR/EC, can be salvaged using thrombolytic treatment to remove fibrin thrombi while preserving histology and enabling transplantation with a clinically acceptable early function.

Translated article] Safety in Dermatologic Procedures: Basic and Advanced Cardiopulmonary Resuscitation

This article in the series on safety in dermatologic procedures covers the delivery of basic cardiopulmonary resuscitation (using no devices), instrumental resuscitation (using an automated external defibrillator), and pharmacological resuscitation (using adrenaline). We provide a brief overview of the updated 2021 European Resuscitation Council guidelines and offer an algorithm and visual aids to support recommended practices.

A comparative study on effectiveness of workshop education versus education via mobile learning (m-learning) in developing medical students’ knowledge and skill about cardiopulmonary resuscitation

INTRODUCTION: A variety of educational approaches are being used today to improve learning in the field of cardiopulmonary resuscitation. Therefore, the present study was conducted to compare workshop education with education via mobile learning (M-learning) in terms of their efficacy in developing medical students’ knowledge and skills about cardiopulmonary resuscitation. MATERIAL AND METHODS: The present study was quasi-experimental performed on 60 interns selected from a university of medical sciences in southwest Iran. Participants were assigned to either the workshop education group (n = 30) or the mobile learning group (n = 30). Before and after the intervention, the knowledge and skills of the participants in terms of basic and advanced cardiopulmonary resuscitation were measured by a questionnaire. The collected data were analyzed using descriptive statistics, Independent-Samples t-Test, Paired-Samples t-Test, and Chi-Square Test in SPSS software v. 22. RESULTS: Education via mobile learning caused a significant increase in the participants’ knowledge about cardiopulmonary resuscitation (p &lt; 0.05). However, this method did not result in a significant difference in the participants’ skill scores, while the workshop education group showed a significant increase in their cardiopulmonary resuscitation skill scores (p &lt; 0.05). CONCLUSIONS: Our results revealed that education via mobile learning was better in enhancing medical students’ knowledge about cardiopulmonary resuscitation. However, workshop education was more effective in developing practical skills in the field of cardiopulmonary resuscitation. Accordingly, educators are recommended to employ a combination of mobile learning and workshop education for achieving better results.

Survival and factors associated with survival with extracorporeal life support during cardiac arrest: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Survival after sudden cardiac arrest (CA) remains low at approximately 10% despite recent advances in cardiopulmonary resuscitation (CPR). Extracorporeal life support (ECLS) may be useful to improve outcomes. However, it is resource intensive and associated with significant complications. We therefore performed a meta-analysis of all available observational studies of patients receiving ECLS-facilitated CPR to estimate the overall survival rate to discharge and predictors of survival. Methods We conducted a literature search in MEDLINE, PubMed EMBASE and the Cochrane Library from inception to September 2020. Studies were included if they focused on ECLS during CPR for CA in adult patients and provided survival data. Results Among the 1745 articles identified by our search, 81 studies involving 9256 patients were included in the analysis. Overall, the pooled estimated survival was 26.2% at discharge and 20.4% with a good neurological outcome. The heterogeneity across studies was significant for both outcomes. Meta-regressions found a significant association between survival at discharge and lower lactate values (b=-0.1, 95% CI [-0.2; -0.05], p=0.002), intrahospital CA (b= 0.005, 95% CI [0.002; 0.008], p= 0.002), and lower CPR duration (b=-0.009, 95% CI [-0.02; -0.002], p=0.02). After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only independent factor associated with survival to discharge (b=0.02, 95% CI [0.007; 0.02], p=0.0004). Conclusion The overall survival rate on discharge of ECLS-facilitated CPR for CA was 26.2%, and the survival with good neurological outcome was 20.4%. An initial shockable rhythm was the only independent predictor of survival to discharge.

Novelties in the pediatric cardiopulmonary resuscitation recommendations and lines of development in Spain

ObjectivesTo analyse the 2020 international and European recommendations for Paediatric cardiopulmonary resuscitation (CPR), highlighting the most important changes and propose lines of development in Spain. MethodsCritical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. ResultsThe most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25 bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. ConclusionsIt is essential that training in Paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.