American Heart Association Cardiopulmonary Resuscitation Research Articles

Cardiopulmonary resuscitation skills profile and knowledge of nurses working in an academic hospital

Introduction and aim: Cardiopulmonary arrest can occur unexpectedly and has a high mortality. Nurses are often the first responders to in-hospital arrest and are expected to initiate cardiopulmonary resuscitation (CPR). It has been identified in the literature that nurses lack the knowledge and the skills of resuscitation. The aim of the study was to determine the CPR skills profile and knowledge among nurses in selected areas at Chris Hani Baragwanath Academic Hospital. Materials and methods: The study was descriptive, prospective and contextual. A self-administered questionnaire, based on the 2010 American Heart Association CPR Guidelines, was used to determine the nurses CPR knowledge. A minimum score of ≥80% was regarded adequate. Results: Total of 133 nurses were recruited; 61 in theatre, 40 in ICU and 32 from the surgical wards. The nurses’ median score (range) for theoretical knowledge was 21% (0% - 79%). No participant achieved ≥80%. No correlation was found between nurses’ knowledge and years of experience (r=0.036, p=0.697). Comparison between knowledge scores and area of work (p=0.060) and accreditation status (p=0.444) were not statistically significant. Conclusion: The knowledge of CPR was found to be poor among nurses and has shown the need for ongoing CPR training to ensure effective resuscitation of patients. Dedicated funding and time to train nurses in CPR should be motivated for.

Virtual Reality and Haptic Cardiopulmonary Resuscitation Training Approaches: A Review

Cardiac arrest is a leading cause of death worldwide preventable with timely application of cardiopulmonary resuscitation (CPR). The American Heart Association CPR guidelines recently have an increased focus on quality of consistent chest compressions and highlighted the need for frequent refresher courses. Literature has shown that standard training manikins do not accurately represent human torso compression forces. Virtual reality (VR) and augmented reality (AR) technologies can simulate or enhance training environments and have shown promise for CPR training. Haptics is the touch element of virtual experiences and the literature has suggested that haptics can produce higher fidelity force feedback over standard training manikins. This review aims to determine the state of research of virtual and AR and haptic-enabled CPR training systems. VR approaches examined feedback, visual kinesthetic manipulation, and gamification. Systems using AR have examined the potential benefits of real-time feedback and quick reference. Haptic approaches have examined different mechanisms and design principles for reproducing realistic human CPR. Hybrid systems explore collaborative training and methods for immersion. These systems offer the potential for immersive training and realistic haptic rendering. However, to reach widespread adoption they must overcome the limitations of cost and mechanical complexity.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study.

Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback. This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs. Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics. Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.

Impact of Change in 2010 American Heart Association Cardiopulmonary Resuscitation Guidelines on Survival After Out-of-Hospital Cardiac Arrest in the United States: An Analysis From 2006 to 2015.

In October 2010, the American Heart Association/Emergency Cardiovascular Care updated cardiopulmonary resuscitation guidelines. Its impact on the survival rate among out-of-hospital cardiac arrest patients (OHCA) is not well studied. We sought to assess the survival trends in OHCA patients before and after the introduction of the 2010 American Heart Association cardiopulmonary resuscitation guidelines in the United States. A retrospective observational study from the National Emergency Department (ED) Sample was designed to identify patients presenting to the ED primarily after an OHCA in the United States between January 1, 2006, and December 31, 2015. The main outcome studied was the change in trends of ED survival and survival-to-discharge rates before and after guideline modification. Among 1 282 520 patients presenting to the ED after OHCA (mean [SD] age, 65.8 [17.2] years; 62% men), ED survival rate (23%) and survival-to-discharge rate (16%) trends showed significant improvement after implementation of the 2010 American Heart Association cardiopulmonary resuscitation guidelines, 1.25% ([95% CI, 0.72%-1.78%] P=0.001) and 0.89% ([95% CI, 0.35%-1.43%] P=0.006), respectively. Notably, among patients with nonshockable rhythm (change in ED survival rate trend, 1.3% [95% CI, 0.89%-1.74%]; P<0.001 and survival-to-discharge trend, 0.94% [95% CI, 0.42%-1.47%]; P=0.004). Among patients admitted to the presenting hospital (n=145 592), 46% were discharged alive, of which 49% were discharged home. Significant decrease in discharge to home was noted (-1.7% [95% CI, -3.18% to -0.22%]; P=0.03), while a significant increase in neurological complication (0.17% [95% CI, 0.06%-0.28%]; P=0.007) was noted with the guideline modification. The change in 2010 American Heart Association cardiopulmonary resuscitation guidelines was associated with only slight improvement in ED survival and survival-to-discharge trends among US OHCA patients and only 1 in 6 OHCA patients survival to discharge.

Metronome Use Positively Affect Cardiopulmonary Resuscitation Parameters: Prospective Observational Multicenter Manikin Study

Objective: Clinical studies have shown that eliminating performer errors is important to ensure high quality cardiopulmonary resuscitation (CPR). Literature on the effects of metronome use on the quality of CPR is scarce. This study aimed to investigate the effect of metronome use on the quality of cardiopulmonary resuscitation. Methods: Thirty volunteer emergency physicians who were divided into 15 groups participated in this prospective, observational, multi-center, manikin study. Firstly, each participant performed conventional CPR on a manikin, and then performed metronome-guided CPR after a short break. Parameters affecting CPR quality were evaluated based on the recommendations of the 2015 American Heart Association CPR and Emergency Cardiovascular Care Guideline. In addition, the fatigue levels of participants were evaluated using the Borg Fatigue Index. Results: Metronome-guided CPR significantly improved the chest compression rate (median (Interquartile Range-IQR); 128 (22) compressions/min vs. 110 (2) compressions/min; 95%CI, p &lt; 0.001), deep compression rate (median (IQR); 95.25 (80) compressions/min vs. 72.63 (105) compressions/min; 95%CI, p &lt; 0.001), compression depth (median (IQR); 62.50 (11) mm vs. 60.25 (14) mm; 95%CI, p = 0.016), ventilation number (median (IQR); 11.25 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.001), high-volume ventilation count (median (IQR); 10.13 (6) ventilations/min vs. 9.50 (1) ventilations/min; 95%CI, p = 0.026), minute ventilation volume (median (IQR); 11.75 (10) L/min vs. 8.03 (3) L/min; 95%CI, p &lt; 0.05), and fatigue levels (median (IQR); 3 (2) vs. 2 (2); in 95%CI, p &lt; 0.05). Conclusions: Our study showed that metronome is a useful device for reaching effective CPR. Metronome guidance may change the CPR parameters positively. This study is in accordance with previous studies which have investigated the effect of metronome-guided CPR on survival.

Ventilation Is an Important Confounding Variable When End-Tidal Carbon Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation

Ventilation Is an Important Confounding Variable When End-Tidal Carbon Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation

Compliance to guidelines in in-hospital cardiopulmonary resuscitation interventions: single-center experience

Purpose: The aim of this study was to investigate standard of knowledge about adult cardiopulmonary resuscitation according to current guidelines and affecting factors among clinicians working at the Hospital of Erciyes University, Medicine School.Materials and Methods: The study conducted on residences and subspecialty residences who accepted to participate and complete the survey. Overall 303 clinicians who accepted to participate and were accessible for completion of survey were recruited to the study. The survey included 2 sections. The first section included data regarding demographic characteristics and the second part included 20 multiple-choice items with one correct answer prepared based on 2010 American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.. Results: Age, total duration of medical practice and residency positively affected standard of knowledge. Higher number of cardiopulmonary resuscitation performed within prior 6 months and defibrillation performance during cardiopulmonary resuscitation positively affected standard of knowledge. Post-graduate theoretical and practical training positively affect standard of knowledge. Conclusion: Cardiopulmonary resuscitation trainings aiming clinicians should be standardized and updated as well as education during employment should be scheduled to provide access to such programs.

Clinical practice and evaluation of management of patients based on clinical pathway of emergency respiratory and cardiac arrest

To explore the effect of clinical pathway of emergency respiratory and cardiac arrest on management of patients with sudden respiratory and cardiac arrest. The clinical data of patients with sudden respiratory and cardiac arrest admitted to Huashan North Hospital Affiliated to Fudan University from 1 year before to 1 year (started in July 2017) after the implementation of clinical pathway of emergency respiratory and cardiac arrest were retrospectively analyzed. The patients who managed by clinical pathway of emergency respiratory and cardiac arrest (from July 2017 to June 2018) were served as observational group, and those manually managed by 2015 American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guide update and the procession in the management of emergency key diseases (from July 2016 to June 2017) were set as control group. The gender, age, underlying disease, the initiation time of cardiopulmonary resuscitation (CPR), the first time of defibrillation, the completion time of endotracheal intubation, the time of venous access, the usage time of the first dose of adrenaline, the usage time of vasoactive drugs, the completion rate of high quality CPR, the success rate of return of spontaneous circulation (ROSC) and the table procedure of clinical pathway were compared between the two groups. There was no statistically significant difference in gender, age or underlying disease between the two groups. Compared with the control group, the clinical pathway could effectively guide the decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, the first time of defibrillation, the completion time of the deep vein catheterization, the usage time of norepinephrine and the completion time of the blood specimen delivery were significantly shortened [the first time of defibrillation (minutes): 1.28±0.86 vs. 2.93±1.61, the completion time of deep vein catheter (minutes): 15.13±2.73 vs. 17.25±3.02, the usage time of norepinephrine (minutes): 15.43±2.80 vs. 17.88±1.67, the completion time of blood specimen delivery (minutes): 7.81±1.42 vs. 9.00±1.03, all P < 0.05]. There was no statistically significant difference in the initiation time of CPR, the completion time of tracheal intubation, the time of peripheral venous access, the usage time of the first dose of adrenaline or sodium bicarbonate, or the success rate of ROSC between the two groups. However, the usage time of the first dose of adrenaline and sodium bicarbonate was shortened in the observation group [the usage time of the first dose of adrenaline (minutes): 3.81±1.22 vs. 4.00±1.32, the usage time of the first does of sodium bicarbonate (minutes): 8.94±3.49 vs. 11.19±3.54, both P > 0.05], and the success rate of ROSC was relatively increased as compared with those in the control group [15.04% (17/113) vs. 12.50% (12/96), P > 0.05]. The clinical pathway of emergency respiratory and cardiac arrest could effectively guide the clinical decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, improve the quality of the resuscitation, and ensure medical safety of emergency department.

Conhecimento da equipe de enfermagem do setor de hemodiálise sobre o atendimento a parada cardiorrespiratória

A parada cardiorrespiratória (PCR) é um dos maiores desafios no qual o profissional de saúde pode se deparar ao longo de sua atuação, pois necessita de uma assistência emergencial que exige competência técnica e científica na execução das manobras de Ressuscitação Cardiopulmonar (RCP). O objetivo foi avaliar o conhecimento dos profissionais de enfermagem que atuam no setor de hemodiálise sobre o atendimento à PCR em adultos, tendo como base as novas diretrizes de RCP da American Heart Association do ano de 2015. Estudo quantitativo realizado no setor de hemodiálise de um hospital de ensino situado Minas Gerais através da aplicação de um questionário fechado contendo 11 questões. Foi classificado como conhecimento satisfatório o número de acertos superior e/ou igual a 60%. Os dados coletados em julho de 2016 e analisados pelo Statistical Package for the Social Sciences (SPSS) versão 23. Participaram do estudo 19 técnicos de enfermagem e um enfermeiro. O número de acertos no questionário variou de um (9%) a seis (54,4%), com média de 4,25 e desvio padrão de 1,25. Apenas 20% dos participantes apresentaram conhecimento satisfatório. O conhecimento dos profissionais de enfermagem do setor de hemodiálise sobre o protocolo de RCP foi insatisfatório, sendo que os mesmos apresentaram lacunas tanto no conhecimento do suporte básico, quanto no suporte avançado de vida.

Cardiopulmonary resuscitation training for undergraduates from nonmedical majors: Effectiveness of the three tiers model.

Integrating cardiopulmonary resuscitation (CPR) in undergraduate education would help to increase the rate of bystander CPR. However, few qualified trainers are available for this purpose. Training student nurses to become CPR trainers on campus could reduce this shortage. The purposes of this study were to assess CPR skills of students from nonmedical majors and to examine the effectiveness of the three tiers model for CPR training. One public university in Jordan. Student nurses and undergraduates from nonmedical majors. Five student nurses attended CPR training courses based on the American Heart Association CPR guidelines. The trainees provided the same CPR training to a sample of 197 undergraduates from nonmedical majors. The participants were asked to imagine a real-life scenario of out-of-hospital cardiopulmonary arrest and to perform CPR on a manikin. Assessment of skills was made before and after training, using a structured observational checklist. In the pretest, participants showed poor CPR skills with a pass rate of only 4%. In the posttest, participants demonstrated significant improvement: t(196) = 26.78, P = 0.00. The three tiers model for CPR training would be an effective strategy to compensate for the shortage in the number of certified CPR trainers.

Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands-Only Cardiopulmonary Resuscitation.

Training middle school students to perform hands-only cardiopulmonary resuscitation (HOCPR) is a potential method to increase overall rates of bystander cardiopulmonary resuscitation (CPR). We aimed to examine the feasibility of teaching this population CPR using teacher-implemented education sessions guided by American Heart Association (AHA) training kits and resources. We conducted a national HOCPR training campaign in middle schools during the 2014-2015 school year. Participating schools utilized AHA CPR training kits to train seventh and eighth grade students. We assessed pretest/posttest knowledge and comfort in performing HOCPR. We recruited 1131 schools and trained approximately 334,610 students in HOCPR. The average pretest score on knowledge questions was 50% and the average posttest score was 84%. Most students (76%) felt comfortable performing HOCPR after the education session. Overall, 98% of teachers said they would continue to implement CPR training in the future. Large-scale, teacher-implemented CPR education sessions in the middle school setting are a successful approach to increase middle school student's knowledge and comfort in performing HOCPR and to increase overall bystander CPR rates.

Cardiopulmonary resuscitation under special pathophysiological conditions: an update of the American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guidelines--2015

Background In clinical work, we often need to perform cardiopulmonary resuscitation in some patients with special pathophysiology. Objective By interpreting the 2015 American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guidelines to update the relevant parts, improve the ability of patients with cardiopulmonary resuscitation. Content Cesarean section in pregnant women with cardiopulmonary resuscitation with attention to the failure of maternal recovery. Pulmonary embolism caused by cardiac arrest, suspected or confirmed cases of early thrombolysis can be carried out, and the diagnosis of cases can also be treated by surgical thrombectomy. Opioid overdose can lead to cardiac arrest, which can be treated with naloxone and cardiopulmonary resuscitation at the same time. Local anesthetics poisoning caused by cardiac arrest during cardiopulmonary resuscitation can be used simultaneously with the rescue of fat emulsion. Cardiopulmonary resuscitation in patients with sudden cardiac arrest during percutaneous coronary intervention. Trends The lack of relevant literature confirms that the pressure of the inferior vena cava in the lower abdomen of the maternal is reduced by hand to the left of the uterus to reduce hypotension. And there is no conclusion about the timing of cesarean section for women. The standard for the treatment of patients with cardiac arrest caused by suspected pulmonary embolism is still controversial. In some cases, intravenous fat emulsions may enhance the efficacy of epinephrine and vasopressin, which has been confirmed by animal studies, but not supported by experimental data. The above aspects are the direction of our future exploration. Key words: Cardiopulmonary resuscitation; Guideline update; Interpretation; Special pathological and physiological

Incidence and Survival After In-Hospital Cardiopulmonary Resuscitation in Nonelderly Adults: US Experience, 2007 to 2012.

Survival trends after in-hospital cardiopulmonary resuscitation (ICPR) for cardiac arrest in nonelderly adults is not well known. Influence of cardiopulmonary resuscitation guidelines on nationwide survival after ICPR is yet to be well elucidated. We examined survival trends and factors associated with survival after ICPR in nonelderly adults aged 18 to 64 years, using Healthcare Utilization Project Nationwide Inpatient Sample Database from 2007 through 2012 in the United States. Furthermore, we studied the impact of 2010 American Heart Association cardiopulmonary resuscitation guidelines on survival. We identified 235 959 patients who underwent ICPR after cardiac arrest. Overall, 30.4% patients survived to hospital discharge. Survival improved from 27.4% in 2007 to 32.8% in 2012 (Ptrend<0.001). Shockable arrest rhythms were noted in 23.3% of patients. Incidence of ICPR increased from 1.81 per 1000 hospitalizations in 2007 to 2.37 per 1000 hospitalizations in 2012 (Ptrend<0.001). There was no statistically significant change in survival trends before and after 2010 cardiopulmonary resuscitation guidelines. Female sex and shockable rhythms were associated with higher adjusted odds of survival, whereas black race, lack of health insurance, age, and weekend admission were associated with lower adjusted odds of survival. Among nonelderly adults, survival after ICPR improved significantly from 2007 through 2012, with an overall survival rate of 30.4%. Incidence of ICPR increased significantly during the study period. There was no statistically significant change in survival before and after 2010 cardiopulmonary resuscitation guidelines. Female sex and black race were associated with higher and lower odds of survival, respectively.

A randomized trial of continuous versus interrupted chest compressions in out-of-hospital cardiac arrest: Rationale for and design of the Resuscitation Outcomes Consortium Continuous Chest Compressions Trial

The Resuscitation Outcomes Consortium is conducting a randomized trial comparing survival with hospital discharge after continuous chest compressions without interruption for ventilation versus currently recommended American Heart Association cardiopulmonary resuscitation with interrupted chest compressions in adult patients with out-of-hospital cardiac arrest without obvious trauma or respiratory cause. Emergency medical services perform study cardiopulmonary resuscitation for 3 intervals of manual chest compressions (each ~2 minutes) or until restoration of spontaneous circulation. Patients randomized to the continuous chest compression intervention receive 200 chest compressions with positive pressure ventilations at a rate of 10/min without interruption in compressions. Those randomized to the interrupted chest compression study arm receive chest compressions interrupted for positive pressure ventilations at a compression:ventilation ratio of 30:2. In either group, each interval of compressions is followed by rhythm analysis and defibrillation as required. Insertion of an advanced airway is deferred for the first ≥6 minutes to reduce interruptions in either study arm. The study uses a cluster randomized design with every-6-month crossovers. The primary outcome is survival to hospital discharge. Secondary outcomes are neurologically intact survival and adverse events. A maximum of 23,600 patients (11,800 per group) enrolled during the post-run-in phase of the study will provide ≥90% power to detect a relative change of 16% in the rate of survival to discharge, 8.1% to 9.4% with overall significance level of 0.05. If this trial demonstrates improved survival with either strategy, >3,000 premature deaths from cardiac arrest would be averted annually.

What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients?

The 2010 American Heart Association guidelines suggested an increase in cardiopulmonary resuscitation compression depth with a target >50 mm and no upper limit. This target is based on limited evidence, and we sought to determine the optimal compression depth range. We studied emergency medical services-treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis clinical trial and the Epistry-Cardiac Arrest database. We calculated adjusted odds ratios for survival to hospital discharge, 1-day survival, and any return of circulation. We included 9136 adult patients from 9 US and Canadian cities with a mean age of 67.5 years, mean compression depth of 41.9 mm, and a return of circulation of 31.3%, 1-day survival of 22.8%, and survival to hospital discharge of 7.3%. For survival to discharge, the adjusted odds ratios were 1.04 (95% CI, 1.00-1.08) for each 5-mm increment in compression depth, 1.45 (95% CI, 1.20-1.76) for cases within 2005 depth range (>38 mm), and 1.05 (95% CI, 1.03-1.08) for percentage of minutes in depth range (10% change). Covariate-adjusted spline curves revealed that the maximum survival is at a depth of 45.6 mm (15-mm interval with highest survival between 40.3 and 55.3 mm) with no differences between men and women. This large study of out-of-hospital cardiac arrest patients demonstrated that increased cardiopulmonary resuscitation compression depth is strongly associated with better survival. Our adjusted analyses, however, found that maximum survival was in the depth interval of 40.3 to 55.3 mm (peak, 45.6 mm), suggesting that the 2010 American Heart Association cardiopulmonary resuscitation guideline target may be too high. http://www.clinicaltrials.gov. Unique identifier: NCT00394706.

Board 234 - Program Innovations Abstract A Seven Year Collaboration Between Three Colleges to Learn Interprofessional Skills During a CPR Team Behavior Simulation (Submission #1037)

Introduction/Background Teamwork failures and breakdowns in communication are consistently associated with adverse events in patient care.1,2 According to statistics released by the Joint Commission in 2004, communication failures are the primary root cause in over 70% of sentinel events.3 Studies have shown that simulation can be used effectively to teach teamwork skills and that skills acquired through simulation can improve student performance in clinical environments.4–9 The purpose of this study was to evaluate the effectiveness of an interprofessional CPR team behavior simulation program in introducing professional entry students at the University of Arizona Health Sciences Center (AHSC) to vital elements of interprofessional collaborative practice.10 In particular, we wanted to assess the impact of this course on student perception of teamwork skills such as closed-loop communication, constructive intervention, knowledge sharing, re-evaluation and summarizing,and mutual respect in the context of a critical code scenario. Methods In the seventh year of the program, we enrolled 374 students from the Colleges of Medicine (n=114), Nursing (n=163) and Pharmacy (n=97) in a cardiopulmonary resuscitation (CPR) simulation course. Simulation exercises were conducted simultaneously over a four week period at the Arizona Simulation Technology and Education Center (ASTEC) and the Steele Innovation Learning Center (SILC) at the University of Arizona. Prior to the simulation exercise, students were provided with the American Heart Association CPR video, reading material and a CPR lecture detailing the critical elements of effective resuscitation team dynamics.11 The students were then assigned to interprofessional teams of five to eight students for a one hour CPR simulation in which the team worked to resuscitate a human patient simulator that had gone into cardiac arrest. The composition of each team was designed to maximize professional heterogeneity. Students were assigned one of the following roles irrespective of their professional training: team leader, chest compressor (2), ventilator, defibrillator, IV/medication administrator, and code recorder. Roles were rotated in repeated iterations of the CPR simulation; each student was given the opportunity to be the team leader. A short debriefing was conducted by trained facilitators after each simulation to reinforce the elements of team dynamics and to discuss ways to improve teamwork in subsequent simulations. Retrospective pre-post surveys were collected to assess the effectiveness of the training on the students’ understanding and perception of core competencies in interprofessional collaborative practice. Survey items were rated on a 5-point qualitative Likert scale. These Results are based on an 81% survey response rate (n=303). Student’s self ratings showed significant improvement in understanding the elements of effective team dynamics (Pre 2.59±1.03, Post 4.14±0.74; P<0.001) and the different roles and responsibilities of the various healthcare providers during CPR (Pre 2.55±1.00, Post 4.11±0.81; P<0.001). Self perceived understanding of behaviors necessary to be an effective team leader during crisis management increased significantly post-training (Pre 3.09±0.92, Post 4.36±0.64; P<0.001). Eighty-nine percent of students felt that the simulation helped them understand the degree to which clear communication leads to better patient outcomes. Pharmacy students rated their initial knowledge lower than medicine and nursing students in all survey questions. Results: Conclusion The interprofessional CPR team behavior simulation provided an effective platform to combine professional students from three colleges in the Healthcare Sciences to emphasize the importance of interdisciplinary collaboration and teamwork in crisis management situations. The simulation improved the student’s knowledge of vital team and communication skills and attitudes towards working in interprofessional teams.

American Heart Association cardiopulmonary resuscitation quality targets are associated with improved arterial blood pressure during pediatric cardiac arrest

AimTo evaluate the association between cardiopulmonary resuscitation (CPR) quality and hemodynamic measurements during in-hospital pediatric cardiac arrest. We hypothesized that AHA recommended CPR rate and depth targets would be associated with systolic blood pressures≥80mmHg and diastolic blood pressures≥30mmHg. MethodsIn children and adolescents <18 years of age who suffered a cardiac arrest with an invasive arterial catheter in place, a CPR monitoring defibrillator collected CPR data which was synchronized to arterial blood pressure (BP) tracings. Chest compression (CC) depths were corrected for mattress deflection. Generalized least squares regression estimated the association between BP and CPR quality, treated as continuous variables. Mixed-effects logistic regression estimated the association between systolic BP≥80mmHg/diastolic BP≥30mmHg and the AHA targets of depth≥38mm and/or rate≥100/min. ResultsNine arrests resulted in 4156 CCs. The median mattress corrected depth was 32mm (IQR 28–38); median rate was 111CC/min (IQR 103–120). AHA depth was achieved in 1090/4156 (26.2%) CCs; rate in 3441 (83.7%). Systolic BP≥80mmHg was attained in 2516/4156 (60.5%) compressions; diastolic≥30mmHg in 2561/4156 (61.6%). A rate≥100/min was associated with systolic BP≥80mmHg (OR 1.32; CI95 1.04, 1.66; p=0.02) and diastolic BP≥30mmHg (OR 2.15; CI95 1.65, 2.80; p<0.001). Exceeding both (rate≥100/min and depth≥38mm) was associated with systolic BP≥80mmHg (OR 2.02; CI95 1.45, 2.82; p<0.001) and diastolic BP≥30mmHg (OR 1.48; CI95 1.01, 2.15; p=0.042). ConclusionsAHA quality targets (rate≥100/min and depth≥38mm) were associated with systolic BPs≥80mmHg and diastolic BPs≥30mmHg during CPR in children.

Impact of the 2005 American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guidelines on Out-of-Hospital Cardiac Arrest Survival

Objective. To describe changes in out-of-hospital cardiac arrest (OOHCA) survival before and after the release of the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). Methods. Data were extracted from an OOHCA registry for 1,681 adult cases of cardiac arrest treated by one emergency medical services (EMS) system between April 1, 2004, and December 31, 2007, in a large city (2005 population 730,657). The primary endpoint was survival to hospital discharge. A convenience sample of 69 electronic electrocardiogram (ECG) recordings was reviewed to assess CPR quality parameters using impedance waveform analysis during corresponding time periods. Intervention. Implementation of the 2005 AHA guidelines for CPR and ECC in spring 2006. Results. The annual treated OOHCA incidence rate was 68/100,000; and the treated ventricular fibrillation (VF) incidence rate was 15/100,000. Bystanders performed CPR in 28% of cases. Public automated external defibrillator (AED) use was < 2% over the entire study, and few patients received hypothermia therapy. Unadjusted OOHCA survival rates were significantly higher in the postguidelines period at 9.4% (n = 1,021) than in the preguidelines period at 6.1% (n = 660), despite similarities in all major predictors of outcome (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1 to 2.4). Bystander-witnessed OOHCA survival for victims in VF on EMS arrival was 19 of 78 (24%) in the preguidelines period versus 34 of 112 (30%) in the postguidelines period (OR 1.4; 95% CI 0.7 to 2.6). CPR quality measures showed significant improvement in the postguidelines period. The mean no-flow fraction in the preguidelines group was 0.46 and dropped to 0.34 in the postguidelines group, a difference of 0.12 (95% CI 0.05 to 0.19). Multivariate regression analysis adjusting for significant predictors of survival showed that OOHCA in the postguidelines period was associated with 1.8 greater odds of survival than in the preguidelines period (95% CI 1.2 to 2.7). Conclusion. In this large city, substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA guidelines for CPR and ECC. These changes were associated with improvements in the quality of CPR.

Survival unchanged 5 months after implementing the 2005 American Heart Association cardiopulmonary resuscitation and emergency cardiac care guidelines for out-of-hospital cardiac arrest

To improve survival from out-of-hospital cardiac arrest, the American Heart Association released guidelines in 2005. We examined the effect of these guidelines on survival in the Resuscitation Outcomes Consortium (ROC) Epistry – Cardiac Arrest. We hypothesized that survival would increase after guideline implementation.