Emergency Cardiopulmonary Resuscitation Research Articles

THE APPLICATION OF THE NEW 2015 AHA GUIDELINES ON UPDATE FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE: ON OCCASION OF A SUCCESSFUL CASE AT HANOI MEDICAL UNIVERSITY HOSPITAL

Cardiac arrest is associated with high mortality if without early diagnosis and cardiopulmonary resuscitation. Each minute without emergency cardiopulmonary resuscitation (CPR), the patient’s chance of survival is reduced by ten percent, even if properly resuscitated but not recirculated, the chance of survival is reduced by four percent. Therefore, CPR should be ferformed as soon as patient is diagnosed with cardiac arrest with the signs of unconsciousness, apnea, loss of carotid pulse and inguinal pulse. Chest compression plays an important role in the success of CPR. There is emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation. Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected. All adult patients with return of spontaneous circulation after cardiac arrest should have targeted temperature management (TTM) to prevent poor neurologic outcome. Key words: Cardiac arrest, targeted temperature management, the 2015 AHA Guideline on CPR and ECC

Practical management of emergencies in primary care: taking simulation out of the classroom and into real-life environments.

General practitioners (GPs) have a responsibility to provide prompt and effective care in an emergency and GPs in the UK are required to undertake annual basic life support (BLS) training. However, most emergencies are peri-arrest and this is an area where GPs lack confidence.1 This may be because life-threatening emergencies in the community are relatively infrequent and therefore provide a challenge for doctors in keeping up to date. The aim of this project was to upskill GPs in managing emergencies that could occur in general practice surgeries. Classroom-based simulation has a track record for teaching and is often used for BLS courses. However, clinicians need to be able to use their own equipment and medication, and be confident managing emergencies within their surgeries. High-fidelity simulation-based training programmes for managing emergencies have been successfully used in hospital settings2 and have been shown to improve knowledge, including emergency cardiopulmonary resuscitation scenarios.3 ,4 To the best of our knowledge, there is no research investigating its value in primary care settings. This highly innovative project brought simulation out of the classroom and into community environments where emergencies actually occur creating ‘real-life’ scenarios. ### Participants Ten workshops were held in general practice surgeries across Dorset and …

Practice and enlightenment of cardio-pulmonary resuscitation emergency training

Objective Based on the international standard cardiopulmonary resuscitation curriculum, the aim of the study is to investigate the effectiveness and importance of the layered cardio pulmonary resuscitation emergency training. Method A total of 219 trainee including clinical medical personnel, auxiliary medical personnel and medical staff with standardized training were enrolled. Training included watching course video, team practice and class discussion, and the theoretical score and operation marks before and after layered cardio-pulmonary resuscitation training were compared. Theoretical score were compared by paired T-test, and operation pass ratio was determined byχ2 analysis. Results The pre-and post-training theoretical score of medical staff with standardized training, auxiliary medical personnel, and clinical medical personnel were 66.60±7.82 vs. 88.60±6.37; 61.60± 7.44 vs. 86.90±5.80; 73.45±6.83 vs. 94.75±5.04 respectively. The pre-and post-training operation pass ratio of marks of medical staff with standardized training, auxiliary medical personnel, and clinical medical personnel were 31.1%/85.2% ; 32.0%/90.7% ; 59.0%/96.4% respectively. Conclusion There are differences in both the theory and operation results of medical personnel at different levels before and after the training of cardiopulmonary resuscitation. The more targeted and layered training is much effective in cardio-pulmonary resuscitation emergency training. Key words: Cardio-pulmonary resuscitation; Emergency training; Training pattern

Mock Codes in a Radiology Department for Systems Improvement and Staff Competency

This article explores the use of mock codes in a radiology area in a 550-bed teaching hospital to see if they identify inadequacies in systems, standards of care, and teamwork that could be remediated in the interest of optimal patient care. Mock codes were run in different units in the radiology department, two newly opened. A total of 38 multidisciplinary responders participated in the mock codes, some from radiology and others from hospital code teams. Responder arrivals and actions were timed and evaluated for teamwork and standards of care. Systems issues were also identified. Debriefing occurred after each session, and participants were asked to complete a postsession evaluation. Significant systems, standards of care, and teamwork shortfalls were identified related to code paging, wayfinding, access to emergency equipment, team leadership, and cardiopulmonary resuscitation. Participants rated the event as a valuable use of their time. Remedial discussions took place during debriefings, and corrective actions began after the sessions. The mock codes were useful exercises that identified systems issues and allowed staff to reflect on their teamwork and resuscitation skills to determine how they could respond more effectively during future events. Remediation included improvements in paging and wayfinding and the implementation of team training and emergency equipment reviews. Continued evaluation will take place using mock codes.

The application of scene simulation teaching on cardiopulmonary resuscitation training for the practice students in emergency department

Objective To compare scene simulation teaching method with traditional methods on training in cardiopulmonary resuscitation (CPR) for the practice students. Methods A convenience sample of 62 nursing students in the emergency department of our hospital in 2014 were recruited as the observation group, and 75 practice students in 2013 were recruited as the control group. The observation group used the scene simulation teaching method for students and the control group used the traditional methods. The students' theoretical knowledge, operation skill of CPR and total score of core capability were compared between two groups. Results The theoretical knowledge, operation skill of CPR and total score of core capability in the observation group were (85.23±6.36), (86.90±4.85), (217.98±6.06), significantly higher than those of the control group, which were (75.36±7.77), (82.38±8.84), (209.33±8.91), t= 8.02, 3.60 and 6.50, P<0.01. Conclusions The scene simulation teaching method is an effective form of emergency department training in CPR, help to improve students practice ability and the ability of emergency cardiopulmonary resuscitation. Key words: Cardiopulmonary resuscitation; Clinical clerkship; Emergency service, hospital; Scene simulation teaching method

Analysis and strategies of pre-hospital emergency care for a community-based population in urban areas of Fuzhou city in 2010

Objective To retrospectively analyze the epidemiological characteristics of pre-hospital emergency care for a community-based population in the urban areas of Fuzhou city and to propose strategies for improving pre-hospital emergency care and the prevention and treatment of common emergency conditions.Methods Data of different sorts of diseases,age,gender,monthly variation in number of cases,time required to response the emergency call and outcome of care were retrospectively analyzed in patients who received pre-hospital emergency care in the urban areas of Fuzhou city in 2010.Results A total of 2130 subjects had pre-hospital emergency care in the urban areas of Fuzhou city.Among them,trauma was the major cause,and was found mainly in youths and adults aged 31-40 years.Cardiovascular and cerebrovascular diseases were the second most common causes and were found mainly in patients aged ＞50 years (especially in those ＞ 70) accounting for 50.57％ in patients of that age cohort.More males than females received pre-hospital emergency care (1.57∶1).A total of 190 patients died during pre-hospital emergency care with trauma (n =69,36.32％),the leading cause of death.Cardiovascular and cerebrovascular diseases were the second leading cause of death and found mainly in patients aged ＞ 50 (n =53) accounting for 81.54％ of deaths in patients of this age cohort.Among patients with sudden death before admission,there was no one had cardiopulmonary resuscitation performed by witness before the emergency care given.Pre-hospital emergency care and pre-hospital deaths were more often occurred in the winter and spring seasons.The time required to response emergency call and the time elapsed to on-site emergency care were (10.0 ± 6.1) min and (11.8 ± 5.9) min,respectively,for patients receiving prehospital emergency care; and the time required to response the emergency call and the time elapsed to onsite emergency care were (11.2 ± 6.2) min and (29.0 ± 21.1) min,respectively,for patients who died during the pre-hospital emergency care.Conclusions (1) It is imperative to provide healthcare education to the community and to improve community awareness of the importance of the disease prevention,especially cardiovascular and cerebrovascular diseases,whereby this would effectively reduce the incidence of emergency care and sudden death.(2) It is also necessary to promote pre-hospital emergency care and cardiopulmonary resuscitation techniques,which are important for improving pre-hospital emergency care and reducing mortality.(3) Strengthening network integration and enforcing the principle of proximity are also important.Coordination between pre-hospital emergency care workers and other relevant departments may improve the efficiency of the Emergency Medical Service System. Key words: Community-based population; Pre-hospital emergency care; Cardiopulmonary resuscitation; Emergency medical service system; Epidemiological survey; Retrospective analysis

EFFECT OF CONTINUOUS OPENING AIRWAY IN EMERGENCE CARDIOPULMONARY RESUSCITATION

ObjectivesTo explore effect of continuous opening airway in emergence cardiopulmonary resuscitation which can hopefully lead to the development of more effective ways to open airway in short period of time.Methods94consecutive...

Principles of Airway Management, 4th Edition

The fourth edition of Principles of Airway Management is a comprehensive work covering virtually all aspects of the adult and pediatric airway that any professional can hope to learn from a textbook. Indeed, its 15 chapters encompass the following topics: anatomy of the airway, evaluation of the airway, basic emergency airway management and cardiopulmonary resuscitation, basic equipment for airway management, the LMA and other supraglottic devices, advanced airway devices (including fibreoptic laryngoscopes, videolaryngoscopes, stylets, and light wands), indications and preparation of the patient for tracheal intubation, techniques of intubation, the difficult airway, pediatric airway management, fibreoptically guided airway management techniques, surgical options in airway management, mechanical ventilation and respiratory care, extubation strategies, and, finally, complications of airway management. This book is well written throughout, and the comprehensive table of contents and index enable the reader to easily find information in this lengthy textbook. The tables and figures have been improved in this edition and most are of good quality. The references are up-to-date. While the preponderance of expertise in airway management can be acquired only through experience, both novices and experts alike will gain insight into airway management by consulting this book. It provides the basic information useful to the beginner and the more advanced content useful to the expert. The book strikes the right balance between theoretical and technical information, which is another important quality. The authors offer the greatest extent of practical ‘‘how to’’ information in a textbook, notably because of the numerous figures. Although this 742-page textbook is indeed quite complete, some advanced techniques, e.g., rigid bronchoscopy, jet ventilation, and lung isolation, are covered hastily and without much technical detail. This is unfortunate since an expert might consult this textbook specifically for information regarding these perhaps less commonly used techniques. In contrast, some topics, e.g., cardiopulmonary resuscitation, are reviewed in surprising detail for a textbook dealing with airway management. Overall, this fourth edition of Principles of Airway Management constitutes a very good reference for any individual or organization interested in airway management. The depth of information goes well beyond that available in more ‘‘general’’ anesthesia textbooks, such as Miller’s Anesthesia, Seventh Edition by Ronald D. Miller and Clinical Anesthesia, Sixth Edition by Paul Barash.

Creating a 21st Century Global Health Agenda

On May 13, 2010, the General Assembly of the United Nations (UN) voted unanimously for UN Resolution 64/265 to hold a High Level Meeting on Non-Communicable Diseases in September 2011. This UN High Level Meeting, to be held in New York, is an unparalleled opportunity to put noncommunicable diseases (NCDs), including cancer, diabetes mellitus, cardiovascular disease, stroke, and chronic respiratory disease, on the global health and development agenda. It also has the potential to secure political commitments from heads of government for a coordinated global response to NCDs, to promote multisectoral action to addressing NCDs within countries, and to ensure that resource allocations for addressing NCDs are more commensurate with their contribution to the global disease burden. Such actions will provide the urgent and necessary momentum to dramatically improve the prevention and management of NCDs for future generations. Our 3 organizations, as well as other partners, are working together to maximize the impact of this meeting. The world can no longer afford to ignore the ever-expanding global social and economic threat posed by chronic diseases. NCDs account for >60% of all deaths globally, and the overall burden of chronic diseases continues to grow.1 By 2030, it is estimated that NCDs will be responsible for 7 in 10 deaths worldwide.2 In addition to the human toll, the economic impact of chronic disease is staggering and will continue to rise. The World Health Organization estimates that the cumulative estimated national income losses attributable to chronic disease from 2005 to 2015 could exceed $1 trillion in just 3 countries: China ($558 billion), Russia ($303 billion), and India ($237 billion).1 Moreover, the chronic disease mortality burden is heaviest in less affluent nations. Of the world's roughly 35 million annual deaths attributable to NCDs, ≈80% occur in low- and middle-income countries.3 …

Emergency Management for Critical Left Main Coronary Artery Stenosis

Increased experience and improvements in technology seem to have encouraged the use of percutaneous interventions for left main coronary artery (LMCA) occlusions. There is no consensus, however, and the data are inadequate on whether surgery or percutaneous procedures should be the intervention of choice for critical occlusions. From January 2002 to December 2006, 108 patients with unprotected LMCA stenosis >80% were treated at our center. Eighty-three patients (77%) underwent bypass grafting and 20 (18%) underwent percutaneous intervention for the purpose of myocardial revascularization. We analyzed parameters demonstrated as risk factors for myocardial revascularization and their predicted effects on outcome. Five patients (5%) died following emergency cardiopulmonary resuscitation before any intervention was performed. The early survival rate was 84.1% in the coronary bypass group and 63% in the percutaneous intervention group. The mean (±SD) survival time was 55.7 ± 2.6 months in the bypass group and 7.6 ± 1.3 months in the percutaneous group. The late-survival rate was also significantly higher in the bypass group. The mean late-survival time was 44.5 ± 3.6 months in the bypass group and 2.3 ± 0.8 months in the percutaneous group. Although emergency percutaneous interventions are lifesaving in some cases, these results clearly demonstrate that coronary bypass grafting should be the intervention of choice for myocardial revascularization in patients with critical LMCA occlusion.

Comparison of Procedural and In-Hospital Outcomes of Percutaneous Balloon Aortic Valvuloplasty in Patients >80 Years Versus Patients ≤80 Years

Percutaneous balloon aortic valvuloplasty (PBAV) is a procedure used for palliation, bridging to surgery, and as an integral step in the procedure for percutaneous aortic valve replacement. Older patients with severe aortic stenosis are thought to have greater risk for adverse perioperative events than younger patients. The aim of this study was to evaluate the outcomes of patients aged >80 years and those aged < or =80 years who underwent PBAV to identify factors associated with adverse clinical outcomes. This was a retrospective study of 111 consecutive patients with severe symptomatic aortic stenosis who underwent retrograde PBAV at Massachusetts General Hospital from December 2004 to December 2008. Forty-nine patients (44%) were men, and the mean age for the whole group was 82 +/- 8 years. Patients were divided into 2 age groups: those aged >80 years (n = 73) and those aged < or =80 years (n = 38). Procedural outcomes, complications, and in-hospital adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Nearly 90% of patients were in New York Heart Association class III or IV. Patients aged >80 years had lower baseline ejection fractions (43.5% vs 56.1%, p <0.01) and smaller aortic valve areas (0.59 vs 0.73 cm(2), p <0.01). Although the 2 age groups had a similar percentage of aortic valve area increase (55.5% vs 45.2%, p = 0.28), those aged >80 years had smaller post-PBAV aortic valve areas (0.89 vs 1.02 cm(2), p <0.05). Overall, in-hospital mortality was 8.1%, with no significant differences between the groups. Advanced age was not an independent predictor of in-hospital death, myocardial infarction, stroke, cardiac arrest, or tamponade; however, patients aged >80 years had a significantly higher incidence of intraprocedural emergent intubation and cardiopulmonary resuscitation compared to the younger group. New York Heart Association class was the only independent predictor of worse in-hospital outcomes. In conclusion, compared to younger patients, those aged >80 years had less favorable preprocedural characteristics for PBAV but similar overall in-hospital clinical outcomes. Patients aged >80 years had significantly higher incidence of emergent intubation and cardiopulmonary resuscitation during PBAV.

A rodent model of emergency cardiopulmonary bypass resuscitation with different temperatures after asphyxial cardiac arrest

Background The use of emergency cardiopulmonary bypass (ECPB) resuscitation after cardiac arrest may offer hope for survival when standard ACLS therapies fail. However, whether cooling adds benefit to ECPB is unknown and we lack an ECPB rodent model for experimental studies. We sought to (a) develop a 72 h survival rodent model using ECPB to treat asphyxial cardiac arrest and (b) use this new model to evaluate early mild and moderate hypothermia versus normothermia during ECPB resuscitation. Methods After 8 min of normothermic asphyxia, three groups of rats were resuscitated with ECPB at 37 °C (NORM), 34 °C (MILD) and 30 °C (MOD) for 1 h ( n = 10 each). During the second resuscitation hour, ECPB was discontinued, ventilatory support was provided and body temperatures were maintained at 37 °C for NORM, 34 °C for MILD, and from 30 °C gradually up to 34 °C in 1 h for MOD animals. From hours 3 to 8, body temperature was maintained at 37 °C for NORM and 34 °C for MILD and MOD animals. Results All rats were initially resuscitated by ECPB. After 72 h, neurological outcome and survival in the MILD (60% survival) and MOD (80%) groups were significantly better than in the NORM (0%) group ( p < 0.05). Overall performance recovery in the MOD group was best (vs. the NORM group), while the MILD group had an intermediate outcome. Conclusions A rodent model of ECPB is feasible and useful for resuscitation studies. The addition of early mild and moderate hypothermia to ECPB resuscitation significantly improves survival compared with normothermic ECPB in rats.

RESUSCITATION AND CRITICAL CARE OF POOR-GRADE SUBARACHNOID HEMORRHAGE

As outcomes have improved for patients with aneurysmal subarachnoid hemorrhage, most mortality and morbidity that occur today are the result of severe diffuse brain injury in poor-grade patients. The premise of this review is that aggressive emergency cardiopulmonary and neurological resuscitation, coupled with early aneurysm repair and advanced multimodality monitoring in a specialized neurocritical care unit, offers the best approach for achieving further improvements in subarachnoid hemorrhage outcomes. Emergency care should focus on control of elevated intracranial pressure, optimization of cerebral perfusion and oxygenation, and medical and surgical therapy to prevent rebleeding. In the postoperative period, advanced monitoring techniques such as continuous electroencephalography, brain tissue oxygen monitoring, and microdialysis can detect harmful secondary insults, and may eventually be used as end points for goal-directed therapy, with the aim of creating an optimal physiological environment for the comatose injured brain. As part of this paradigm shift, it is essential that aggressive surgical and medical support be linked to compassionate end-of-life care. As neurosurgeons become confident that comfort care can be implemented in a straightforward fashion after a failed trial of early maximal intervention, the usual justification for withholding treatment (survival with neurological devastation) becomes less relevant, and lives may be saved as more patients recover beyond expectations.

Cardiac Arrest After Methylprednisolone Pulse Therapy Rescued Using Extracorporeal Membrane Oxygenation in Patients With Acute Cardiac Rejection: Two Case Reports

Patients receive methylprednisolone pulse therapy (MPT) when acute cardiac rejection occurs. Although the regimen is generally safe and effective, severe complications occasionally develop. From 1997 to 2007, there were 210 cardiac transplantation procedures performed at our hospital. Among these patients, there were 23 episodes of acute rejection treated with MPT, 10 mg/kg/d. Two patients in our series had cardiac arrest within 36 hours after initiating the therapy. Endomyocardial biopsy specimens showed International Society for Heart Transplantation grade 1B allograft rejection in both cases. Emergent intubation and cardiopulmonary resuscitation were performed. Venoarterial extracorporeal membrane oxygenation (ECMO) was used to rescue the patients. The cardiac function in both patients recovered gradually. Left ventricular ejection fraction increased from 16.2% to 47% in one patient and from 27% to 30% in the other patient. One patient was successfully weaned from ECMO after 2 days of support. The other patient was discharged against medical advice because of hypoxia-related brain death after 3 days. Both patients had a history of tachyarrhythmias before initiation of MPT. Although the relationship between mechanisms of cardiac arrest and MPT is uncertain, the risk of cardiac arrest cannot be overlooked when initiating MPT, especially in patients with a history of tachyarrhythmia. Meanwhile, ECMO can serve as a rescue method if cardiac arrest occurs.

Colonoscopy practice in Italy: A prospective survey on behalf of the Italian Association of Hospital Gastroenterologists

Examining the current practice is important for the benchmarking of quality of colonoscopy and the comparison with the standards and recommendations expected by professional societies. To describe colonoscopy practice in Italy, on the basis of prospective analysis of a large number of examinations performed by operators with different levels of expertise in a wide range of unselected centres. Cross-sectional, prospective and multicentre study. The main features of each endoscopy centre (structure indicators) were collected through the use of a standardised questionnaire. A second questionnaire was used to prospectively record details of all the consecutive colonoscopies performed in a 2-week study period. Data from 278 centres and 12,835 consecutive colonoscopies were evaluated. Centres were uniformly distributed throughout Italy - north, centre and south - as was their organizational complexity and workload. Overall, adequate facilities (i.e. cleaning area for disinfection/reprocessing, equipped recovery room), and safety equipment (i.e. pulse oximetry, equipment for emergency cardiopulmonary resuscitation) were lacking in a considerable amount of centres, especially in those with a lower degree of organizational complexity. Written informed consent was routinely required in 87% of the centres, but a specific consent for colonoscopy, including detailed information on adverse events, was adopted by 66%. Regular programs for recording some quality indicators (i.e. cecal intubation, quality of bowel cleansing, patients' satisfaction and complications) were implemented in a minority of centres. About 93% of the colonoscopies were performed for diagnostic purpose; screening and surveillance accounted for 13.7% and 25.3% of the indications, respectively. Sedation and/or analgesia was administered in about half of the patients. Overall, colonoscopies were completed to the cecum in 80.7% of cases, and only 22.1% of the centres reported a cecal intubation rate >or=90%; this figure was reported in 33.1% of centres with high-organizational complexity and in 14.4% of outpatient units. The overall incidence of immediate complications was low (2 perforations, 26 bleedings and 32 serious cardiorespiratory complications). This study documented a wide variation in colonoscopy practice between centres and highlighted problem areas where interventions are needed to improve performance and safety of the examinations.

Cardiopulmonary bypass as an adjunct for the noncardiac surgeon

The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.

Anaphylactoid syndrome of pregnancy immediately after intrauterine pressure catheter placement

A 35-year-old multipara woman underwent intrauterine pressure catheter placement during labor. Immediately afterwards, she had severe dyspnea develop, became unresponsive, and had a prolonged fetal bradycardia. During emergency cesarean section, she required cardiopulmonary resuscitation repetitively. She then had disseminated intravascular coagulopathy develop and underwent hysterectomy. Anaphylactic reaction may be associated with intrauterine pressure catheter placement.

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

Outcomes After Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: Expanding the Chain of Survival

Coronary heart disease is the most common cause of death in the United States, with ventricular fibrillation (VF) the most common initial rhythm when cardiac disease causes arrest. Survival after VF out-of-hospital cardiac arrest (OHCA) depends on a sequence of events called the chain of survival, which Includes rapid access to emergency medical services, cardiopulmonary resuscitation, defibrillation, and advanced care. Because of widespread implementation of defibrillation programs, more patients survive VF OHCAs, making subsequent care of these patients important. Early hospitalization must focus on potential neurologic injury and therapy targeted at the underlying cardiac disease and antiarrhythmic therapy for long-term secondary prevention of sudden death. Attention to certain cohorts who are at high risk despite their underlying disease, such as women and elderly patients, is necessary. These cohorts may have the greatest response to short-term and long-term therapies for cardiac rehabilitation. With these approaches, long-term survival and quality of life after VF OHCA are favorable. Broadening the focus of the chain of survival to include in-hospital and long-term care will further improve favorable outcomes achieved in an early defibrillation program.

The Experience of Teaching Emergency Management and Cardiopulmonary Resuscitation to Medical Students in Busan

Purpose: The aim of this study was to describe the experience of teaching emergency management and cardiopulmonary resuscitation to medical students in Busan. Methods: Study participants were 59 medical students in Busan. An eight-day curriculum in the emergency management and cardiopulmonary resuscitation was developed, They completed all class sessions and two drill/practical examinations taught by our interdisciplinary team from July 21 through 30, 2003, Each class is approximately 2 hours and reading assignments are given at the end of each class, Also included are practical, table-top and team-building exercises. The participants completed self-reported questionnaires for the education. Results: About establishment and environment of the education, respondents answered with 'very good' were 14%, About overall theoretical lecture, respondents answered with 'very helpful' were lower than 40%, Especially, favorable evaluation for the medical lectures was lower than that of other lectures, Students generally enjoyed their emergency medicine experience as it is often their first opportunity to assume primary responsibility for patient care. About overall practices, respondents answered with 'very helpful' were higher than 60%. Conclusion: The authors found that medical students prefer opportunities to hone procedural skills than to hear theoretical lectures. Also, medical students are welcome to hear theoretical lectures that consists of emergency management related contents, not academically medical contents. This curriculum should be tailored to fulfill learner's requirements.