Cardiopulmonary Resuscitation Guidelines Research Articles

Safe Lines to Life Savers—A Focus on Rescuer Safety

Abstract Objective To describe and discuss the new cardiopulmonary resuscitation (CPR) guidelines during the coronavirus disease 2019 (COVID-19) period. Background The ongoing COVID-19 pandemic has affected the entire humankind despite immense efforts by the government, like mandatory personal protection, lockdown, and so forth. Numerous health care workers (HCW) lay rescuers during resuscitation are at risk of acquiring infection. This resulted in the formulation of additional guidelines during CPR, specific to COVID-19. Method A narrative overview of new resuscitation guidelines made for protecting rescuers during COVID-19 by American Heart Association (AHA), European guidelines on resuscitation update, Research Society of Anesthesiology and Clinical Pharmacology, and Indian Resuscitation Council (IRC). Discussion An overview of all new steps of resuscitation starting from the checking responsiveness of the patient, rescuer safety, control of aerosolization, number of team members, CPR, airway management, drugs and dosages, defibrillation, appropriateness of continuing resuscitation, and discussing the changes made in standard guidelines.

How Does Rescuer Fitness Affect the Quality of Prolonged Cardiopulmonary Resuscitation?

Objective: High quality cardiopulmonary resuscitation (CPR) is crucial for patients experiencing cardiac arrest. CPR quality declines within the first few minutes of CPR performance. Being more fit is associated with higher CPR quality, yet the fitness parameters needed remain uncertain. It is also unknown how CPR quality is affected during a protocol of realistic CPR when rescuers switch compressors every two minutes, as recommended by the American Heart Association (AHA), and extended duration, as might be encountered with an out-of-hospital cardiac arrest. The purpose of the present study is to determine the extent to which different measures of physical fitness predict high quality CPR performance when rescuers follow current CPR guidelines. Methods: Subjects underwent a fitness assessment evaluating lower back muscular endurance, abdominal muscular endurance, upper body muscular strength, and upper body anaerobic power. At least 48 hours later, subjects returned to the laboratory for CPR testing. CPR quality was determined by compression rate (>100/minute), compression depth (>2 inches, or 50 mm), and adequate (full) chest recoil between compressions, based on American Heart Association guidelines. A CPR Quality Score, designed to represent cardiac output, was calculated as the product of compression rate and depth. Results: Thirty-three of 42 subjects were able to achieve a CPR Quality Score greater than 5000, the minimum needed to meet AHA recommendations. Higher anaerobic power and bench press scores were predictive of both high CPR Quality Scores (R2=0.47) and compression depth (R2=0.47). Sex (female) was predictive of better chest compression recoil percentages (R2=0.15). Conclusion: Most rescuers can maintain high quality CPR if given two minute breaks between cycles. Rescuers with high anaerobic fitness and muscular strength may be able to provide higher quality CPR.

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.

Improving CPR Quality by Using a Real-Time Feedback Defibrillator During Pediatric Simulation Training.

The aim of this study was to assess the effectiveness of a defibrillator with real-time feedback during code team training to improve adherence to the American Heart Association (AHA) resuscitation guidelines. This is a retrospective cohort study designed to compare pediatric resident adherence to the AHA cardiopulmonary resuscitation guidelines before and after use of real-time feedback defibrillator during code team training simulation. After institution of a real-time feedback defibrillator, first-year resident's adherence to the AHA guidelines for chest compression rate (CCR), fraction, and depth during code team training from January 2017 to December 2018 was analyzed. It was then compared with results of a previously published study from our institution that analyzed the CCR and fraction from January 2015 to January 2016, before the implementation of a defibrillator with real-time feedback. We compared 19 eligible session preintervention and 36 postintervention sessions. Chest compression rate and chest compression fraction (CCF) were assessed preintervention and postintervention. The depth of compression was only available postintervention. There was improvement in the proportion of code team training sessions with mean compression rate (74% preintervention vs 100% postintervention, P = 0.003) and mean CCF (79% vs 97%, P = 0.04) in adherence with the AHA guideline. The use of real-time feedback defibrillators improved the adherence to the AHA cardiopulmonary resuscitation guidelines for CCF and CCR during pediatric resident simulation.

Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960....

Resuscitation Care in Out-Of-Hospital Cardiac Arrest: a Survey of the Emergency Medical Services Personnel in the Republic of Crimea

Introduction. The choice of the ways for optimizing management of out-of-hospital cardiac arrest by emergency medical services (EMS) should be based on the evidence from existing practice of resuscitation care. The study was aimed at evaluating personal experience of cardiopulmonary resuscitation (CPR) performance, timing of last training in resuscitation and level of self-perceived knowledge and skills of CPR among the employees of the EMS of the Republic of Crimea, as well as to assess their beliefs on significance of individual CPR procedures in terms of influence on success of resuscitation and to study their perceptions on factors that may have positive or negative impact on effectiveness of resuscitation care.Material and methods. An anonymous survey of the EMS personnel of the Republic of Crimea was conducted in July–December 2019. The questionnaire was utilized to collect demographic data, information on experience of conducting CPR for the last year, on a current practice of CPR debriefings and timing of last CPR training. The participants assessed their knowledge and skills of CPR and their perception of influence of early implementation of individual CPR procedures on success of resuscitation on a 5-point Likert scale, and indicated factors, that may limit or enhance the effectiveness of resuscitation.Results. A total of 251 specialist of the EMS participated in the survey, including 63 physicians, 129 feldshers and 4 nurses of ambulance teams, 45 dispatchers and 5 senior officers of the EMS stations, which corresponds to 28.8% of physicians, 13.0% of feldsher/nursing staff and 17.4% of dispatcher specialists of the republic. Percentage of male respondents was 35.5%, mean age — 41.5 years, mean duration of EMS work experience — 15.5 years. The mean declared number of cases of CPR conducted in the last 12 months was 2.2 (range: 0–20), and 23.5% specialists of the ambulance teams have not participated in any CPR attempt over the last year. About 60.2% respondents were trained in CPR within the last year. When compared to other specialists of ambulance teams, feldshers who work alone (without a coworker), were significantly less commonly performing a real-life resuscitation (p=0.008) or receiving training in CPR (p=0.020). Dispatchers were least covered with resuscitation training (only 33.3% were trained within the last year) and had the lowest level of CPR knowledge and skills. 25.9% of the specialists had an erroneous judgement that early drug administration and/or tracheal intubation have higher influence on success of resuscitation when compared to chest compressions and/or defibrillation. The level of knowledge and skills of CPR depend on the timing of last training (p<0.001).Conclusions. The experience of participation in real-life attempts of CPR is severely limited for considerable part of the EMS employees, and many specialists have not been trained in resuscitation for a long time. The perceptions of the EMS specialists regarding the importance of individual CPR procedures are not always compliant with the statements of current international CPR guidelines. In order to enhance the effectiveness of resuscitation care in the Republic of Crimea, it is advisable to monitor the coverage of the EMS employees with resuscitation training and the rates of their participation in resuscitation attempts, as well as to perform additional targeted training in CPR, in particular, using alternative methods of education.

Timing of Intravenous Epinephrine Administration During Out-of-Hospital Cardiac Arrest.

Current guidelines for cardiopulmonary resuscitation recommend that standard dose of epinephrine be administered every 3 to 5 min during cardiac arrest. However, there is controversy about the association between timing of epinephrine administration and outcomes after out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the timing of intravenous epinephrine administration is associated with outcomes after OHCA. We analyzed Japanese government-led nationwide population-based registry data for OHCA. Adult OHCA patients who received intravenous epinephrine by emergency medical service personnel in the prehospital setting from 2011 to 2017 were included. Multivariable logistic regression models were used to assess the associations between time to first epinephrine administration and outcomes after OHCA. Subsequently, associations between early (≤20 min) versus delayed (>20 min) epinephrine administration and outcomes after OHCA were examined using propensity score-matched analyses. The primary outcome was 1-month neurologically favorable survival. A total of 119,946 patients (mean [SD] age, 75.2 [14.8] years; 61.4% male) were included. The median time to epinephrine was 23 min (interquartile range, 19-29). Longer time to epinephrine was significantly associated with a decreased chance of 1-month neurologically favorable survival (multivariable adjusted OR per minute delay, 0.91 [95% CI, 0.90-0.92]). In the propensity score-matched cohort, when compared with early (≤20 min) epinephrine, delayed (>20 min) epinephrine was associated with a decreased chance of 1-month neurologically favorable survival (959/42,804 [2.2%] vs. 330/42,804 [0.8%]; RR, 0.34; 95% CI, 0.30-0.39; NNT, 69). Delay in epinephrine administration was associated with a decreased chance of 1-month neurologically favorable survival among patients with OHCA.

COVID-19: cardiopulmonary resuscitation in the dental practice

Phil Jevon and Puja Jalota offer an overview to the current guidelines relating to the cardiopulmonary resuscitation (CPR) of a patient with suspected or confirmed COVID-19 infection Aim To understand the Resuscitation Council UK COVID-19 cardiopulmonary resuscitation guidelines. Objectives Discuss Public Health England's COVID-19 risk pathways. Describe the level 2 PPE COVID-19 cardiopulmonary response. Describe the level 3 PPE COVID-19 cardiopulmonary response. GDC development outcome C

A study of cardiopulmonary resuscitation literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 cardiopulmonary resuscitation guidelines.

INTRODUCTION:Cardiopulmonary resuscitation (CPR) is regarded as the most important skill of the medical staff who is required to be aware of the latest changes to the CPR guidelines so that they can take the most effective actions in the critical conditions of CPR. Therefore, the present study aimed to determine the levels of CPR literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 CPR guidelines in 2019.MATERIALS AND METHODS:In this descriptive, analytical, cross-sectional study, 525 subjects were selected as the sample population using the two-stage cluster sampling. For data collection, a researcher-made questionnaire was used, whose content validity and reliability were confirmed (r = 0.71). The study screened the data received and analyzed valid data set through the ttest and Spearman's correlation coefficient by incorporating SPSS Statistics software version 23.0. In addition, P < 0.05 was considered statistically significant.RESULTS:The 2015 CPR literacy levels of the samples were as follows: excellent (85 subjects or 16.2%), good (404 subjects or 77%), and average (36 subjects or 6.9%). The results of Pearson's correlation coefficient revealed a weak and inverse relationship between the levels of CPR literacy and the age of samples (r = −0.092) and work experience (−0.029), which were statistically significant. In addition, the results of Mann–Whitney U-test demonstrated that the level of CPR literacy among the personnel of Ahwaz University of Medical Sciences exceeded that among the personnel of Kermanshah University of Medical Sciences (P < 0.001).CONCLUSION:It is suggested that in retraining the nursing and paramedical personnel, CPR be carried out with more emphasis on the changes introduced in this guideline compared to that in 2010, including esophageal tracheal airway, reasons for the cessation of CPR, intraosseous infusion, and induced hypothermia.

Applications of capnography in airway management outside the operating room

The capnograph is vital for patient monitoring in the operating room. Its clinical applications for airway management outside the operating room are being increasingly recognized due to its role in the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guidelines. Capnography can be used for the detection of respi-ratory depression during procedural sedation, verification after emergency endotracheal tube intubation, assessment of the airway and circulation during cardiopulmonary resuscitation, and continuous monitoring during patient transportation and in intensive care settings. This can be especially beneficial for pediatric patients, those who are critically ill, and patients with a difficult airway.

Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

1. Newborn resuscitation requires anticipation and preparation by providers who train individually and as teams. 2. Most newly born infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with their mothers after birth. 3. Inflation and ventilation of the lungs are the priority in newly born infants who need support after birth. 4. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions. 5. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals. 6. Chest compressions are provided if there is a poor heart rate response to ventilation after appropriate ventilation corrective steps, which preferably include endotracheal intubation. 7. The heart rate response to chest compressions and medications should be monitored electrocardiographically. 8. If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route. 9. Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion. 10. If all these steps of resuscitation are effectively completed and there is no heart rate response by 20 minutes, redirection of care should be discussed with the team and family. It is estimated that approximately 10% of newly born infants need help to begin breathing at birth,1–3 and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function.4,5 The neonatal mortality rate in the United States and Canada has fallen from almost 20 per 1000 live births6,7 in the 1960s to the current rate of approximately 4 per 1000 live births. The inability of newly born infants to establish and sustain adequate or spontaneous respiration contributes significantly to these early deaths and to the burden of adverse neurodevelopmental outcome among survivors. Effective and timely resuscitation …

Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

1. High-quality cardiopulmonary resuscitation (CPR) is the foundation of resuscitation. New data reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation. 2. A respiratory rate of 20 to 30 breaths per minute is new for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving rescue breathing and have a pulse. 3. For patients with nonshockable rhythms, the earlier epinephrine is administered after CPR initiation, the more likely the patient is to survive. 4. Using a cuffed endotracheal tube decreases the need for endotracheal tube changes. 5. The routine use of cricoid pressure does not reduce the risk ofd regurgitation during bag-mask ventilation and may impede intubation success. 6. For out-of-hospital cardiac arrest, bag-mask ventilation results in the same resuscitation outcomes as advanced airway interventions such as endotracheal intubation. 7. Resuscitation does not end with return of spontaneous circulation (ROSC). Excellent post–cardiac arrest care is critically important to achieving the best patient outcomes. For children who do not regain consciousness after ROSC, this care includes targeted temperature management and continuous electroencephalography monitoring. The prevention and/or treatment of hypotension, hyperoxia or hypoxia, and hypercapnia or hypocapnia is important. 8. After discharge from the hospital, cardiac arrest survivors can have physical, cognitive, and emotional challenges and may need ongoing therapies and interventions. 9. Naloxone can reverse respiratory arrest due to opioid overdose, but there is no evidence that it benefits patients in cardiac arrest. 10. Fluid resuscitation in sepsis is based on patient response and requires frequent reassessment. Balanced crystalloid, unbalanced crystalloid, and colloid fluids are all acceptable for sepsis resuscitation. Epinephrine or norepinephrine infusions are used for fluid-refractory septic shock. More than 20 000 infants and children have a cardiac arrest per year in the …

Part 4: Pediatric basic and advanced life support 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care

Part 4: Pediatric basic and advanced life support 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care

Kardiopulmonalna reanimacija u položaju na trbuhu

Cardiopulmonary resuscitation (CPR) is a series of life-saving procedures aimed at restoring and maintaining the functions of breathing and circulation in patients suffering from cardio-respiratory arrest. Old and new CPR guidelines assume that the patient is lying on the back, on a hard and stable surface. The prone position where the patient is lying on the stomach is often used in the operating room to enable an easier approach to the operative field and in intensive care units (ICU) to enable better oxygenation for patients in advanced stages of hypoxic respiratory insufficiency. During the COVID-19 pandemic, patients suffering from the infection are often treated in the prone position. Should cardiac arrest occur, it is necessary to initiate high-quality chest compressions and early defibrillation as soon as possible for the patient to have the best chance of survival. Current guidelines stipulate that CPR should be initiated immediately, even in the prone position, and kept up until conditions are met for the patient to be turned over onto the back. It is recommended to place hands on the patient's back at the level of the T7-T10 vertebrae and perform chest compressions with the usual strength and velocity (5-6 cm deep, 2 compressions per second). For defibrillation, self-adhesive disposable electrodes should be placed in an anterior-posterior or a bi-axillary position. Sternal counterpressure could increase the efficacy of chest compressions. Educating health workers to perform this CPR technique and using it in selected patients can increase survival.

Assessment of Cerebral Blood Oxygenation by Near-Infrared Spectroscopy before and after Resuscitation in a Rat Asphyxia Cardiac Arrest Model.

Clinical investigators have focused on the real-time evaluation of cerebral blood oxygenation (CBO) by near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR). A previous study showed that an abrupt increase of oxy-hemoglobin (Hb) level and tissue oxygenation index (TOI) was associated with the timing of return of spontaneous circulation (ROSC). However, it is not clear how TOI alters before and after CPR including a period of cardiac arrest (CA). Therefore, this study aimed to assess CBO with asphyxia CA and its association with CPR to ROSC in rats. Male Sprague-Dawley rats were used. We attached NIRS (NIRO-200NX, Hamamatsu Photonics, Japan) from the nasion to the upper cervical spine in rats. A ten-minute asphyxia was given to induce CA. After CA, mechanical ventilation was restarted, and manual CPR was performed. We examined the mean arterial pressure (MAP), end-tidal carbon dioxide (ETCO2), and Oxy/Deoxy-Hb and TOI. Out of 14 rats, 11 obtained sustained ROSC. After the induction of asphyxia, a rapid drop of TOI was observed, followed by a subsequent increase of Oxy-Hb, Deoxy-Hb, and TOI with CPR. Recent CPR guidelines suggest the use of ETCO2 during CPR since its abrupt increase is a reasonable indicator of ROSC. In this study, abrupt increases in MAP, ETCO2, and TOI were observed at the time of ROSC. TOI can be an alternative to ETCO2 for identifying ROSC after CA, and it also has the capability of monitoring CBO during and after CPR.

Extensive symmetrical skin necrosis and cutaneous blisters after vasopressin infusion in a 5-year-old child with catecholamine-resistant cold shock

Vasopressin is recommended as a rescue vasoconstrictive agent in severe pediatric vasodilatory shock. Still there are no convincing literature on the use of vasopressin in high-systemic vascular resistance shock and in pediatric cardiac arrest. The authors report a case of catecholamine-resistant cold shock developing extensive skin necrosis with multiple blisters after high-dose vasopressin use via a central venous catheter. A 5-year-old previously healthy female child presented to emergency department unresponsive with no central pulse. The child required cardiopulmonary resuscitation multiple times in pediatric ICU for intractable hyperkalemia and for mixed cardiogenic and catecholamine-resistant cold shock. Emergency hemodialysis was done, starting high-dose vasopressin to maintain cardiac perfusion. Vasodilator milrinone infusion was started after 12 h. Cardiac output gradually improved, and vasoconstrictive inotropes were weaned off on day 3. However, the child developed bilateral extensive skin necrosis and multiple bullae on both hands and foot on days 2–3, which required multiple debridements. Skin and digital perfusion then gradually improved in next 72 h avoiding the need for amputation. Vasopressin has been included in Adult Cardiopulmonary Resuscitation Guideline as a second vasopressor to epinephrine. Although vasopressin is used widely in pediatric vasodilatory shock, its use in cardiac arrest resuscitation and cold shock scenario remains questionable. Many cases of extensive skin necrosis after peripheral vasopressin extravasation have been reported in adults. In our case, vasopressin infusion was given through a central venous line. We observed that concomitant use of vasodilators may reduce skin and digital gangrenous complications of vasopressin. We conclude that vasopressin infusion should be used with extreme caution in catecholamine-refractory septic cold shock.

Small animal cardiopulmonary -resuscitation (CPR) in general practice

Cardiopulmonary arrest (CPA) is the acute cessation of systemic perfusion and ventilation. It leads to a lack of tissue oxygen delivery and, if not addressed quickly, will inevitably cause death. Cardiopulmonary resuscitation (CPR) is the only available treatment for CPA and several opportunities exist to improve the veterinary team's resuscitation approach and optimize small animal CPR patient outcomes. In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative generated evidence-based clinical guidelines to form the basis for training and practice of CPR in dogs and cats. When employing an evidence-based, standardized approach to small animal CPR, return of spontaneous circulation can be achieved in up to 58% of patients and up to 7% of dogs and 19% of cats can be discharged from the veterinary hospital alive. Survival for dogs and cats that suffer CPA is best in patients that suffer a peri-anesthetic arrest, so high quality CPR in the anesthesia patient population is of utmost importance and expected to be the most rewarding. To ensure the best possible outcomes for any patient suffering from CPA and undergoing CPR, a comprehensive resuscitation strategy is necessary, that includes preventive and preparedness measures, basic life support (chest compressions and ventilation), advanced life support (optimization of the patient status by targeted drug therapy, cardiac rhythm monitoring, and defibrillation), and post-cardiac arrest critical care. This article summarizes the most important RECOVER CPR guidelines for the small animal practitioner.

An investigation into specialist practice nurses' knowledge of cardiopulmonary resuscitation guidelines in a tertiary hospital in Gauteng Province, South Africa.

Background Cardiac arrest is among the major causes of sudden deaths globally. Although out-of-hospital cardiac arrest occurs more commonly, in-hospital cardiac arrest is still a major health problem. Critical care areas provide care to critically ill patients who are at risk of cardiac arrest. It is important that nurses are knowledgeable and competent in cardiopulmonary resuscitation (CPR) in order to optimise the patient’s chances of survival and quality of life after cardiac arrest. Objectives To investigate specialist practice nurses’ knowledge of evidence-based guidelines for CPR Methods A descriptive cross-sectional survey was utilised. We sampled all critical care registered nurses (n=96) currently working in the adult emergency departments and intensive care units at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa. A self-administered instrument, the ‘evaluation questionnaire on CPR knowledge for health personnel from emergency services’ was used. Data were analysed using descriptive and comparative statistics. Results The mean CPR knowledge score was 46%. A score of 84% was considered adequate for a pass, and no respondents achieved this score. The majority of the respondents (80.85%; n=76) were specialists in the field of intensive care nursing. Conclusion The CPR knowledge of specialist practice nurses was suboptimal for the care required in high-risk settings. Further training is indicated. Contributions of the study We showed that specialist nurses working in critical care environments at a public hospital in Johannesburg scored poorly in a CPR knowledge test.

Abstract 231: Single Bystander CPR Performance During Drone AED Delivery for Simulated Out of Hospital Cardiac Arrest

Background: Drones have great potential to speed the delivery of AEDs in the critical first few minutes of OHCA. However, it is unclear whether bystanders can balance high-quality cardiopulmonary resuscitation (CPR) with AED deployment. The 2015 AHA CPR guidelines recommend a chest compression (cc) rate of 100-120/minute, cc depth of 50-60mm, and cc fraction of &gt;60%. Method: We performed mock cardiac arrest simulations using bystander volunteers, including simulated 911 call, telephone-assisted dispatcher CPR instructions, bystander CPR, drone-delivered AED, and AED application. CPR performance was recorded by a Laerdal Resusci Anne Quality Feedback System and compared between two groups of participants: recent CPR training (&lt;2 years) versus remote (&gt;2 years) or no CPR training. Prior data had shown CPR skill degradation after 2 years. Chi-squared tests compared demographics; T-tests compared age and CPR performance data. Results: Between 9/2019-3/2020, 5 simulations were conducted with 51 participants. The mean age was 39.7 years, 56.9% were female, and 78.4% had a college or graduate degree. Racial/ethnic makeup consisted of 64.7% White, 15.7% African-American, 15.7% Asian, and 11.8% Hispanic. 41.2% had recent CPR training (n=21); 58.8% had remote CPR training (n=19) or no CPR training (n=11). There were no differences in demographics by CPR training groups. Participants with recent CPR training had shorter time from CPR initiation to AED shock delivery (3:45 vs. 4:14 [min:sec], p=0.01) and a trend toward higher percent of time with cc depth (77.4% vs 50.4%, p=0.11) and higher cc fraction (46.8% vs 42.9 %, p=0.12). There were no differences for percent of time with cc rate or CPR recoil. Conclusion: Overall, CPR quality was low regardless of prior CPR training status. Those recently trained had shorter resuscitation time and appeared to have better CPR performance. Realization of a drone AED networks may require novel CPR programs focused on high-quality CPR.

The «Absolute Futility» isn't Absolute: Concerning the Necessity of Reconsideration of Existing Time-Based Criterion for Stopping Resuscitation Attempt

Despite the progress in the modern resuscitation science, optimal duration of a cardiopulmonary resuscitation (CPR) attempt is not defined yet.It seems appropriate to initiate an open discussion within the Russian medical research community, concerning the development of uniform legislated criteria for stopping resuscitation, considering the best scientific evidence and current international guidelines, with subsequent introduction of harmonized amendments to the clinical practice guidelines for CPR.