Cardiopulmonary Resuscitation Maneuvers Research Articles

Echocardiography in Cardiac Arrest: Incremental Diagnostic and Prognostic Role during Resuscitation Care.

Cardiac arrest (CA) is a life-critical condition. Patients who survive after CA go into a defined post-cardiac arrest syndrome (PCAS). In this clinical context, the role of the echocardiogram in recent years has become increasingly important to assess the causes of arrest, the prognosis, and any direct and indirect complications dependent on cardiopulmonary resuscitation (CPR) maneu-vers. We have conduct a narrative revision of literature. The aim of our review is to evaluate the increasingly important role of the transthoracic and transesophageal echocardiogram in the CA phase and especially post-arrest, analyzing the data already present in the literature. Transthoracic and transesophageal echocardiogram in the CA phase take on important diagnostic and prognostic role.

Sugamadex na reversão da anafilaxia induzida por rocurônio em paciente pediátrico: relato de caso e revisão de literatura

INTRODUCTION: Among neuromuscular blockers (NMB), rocuronium is the most notably cited as a cause of anaphylactic reaction. Rocuronium-induced anaphylaxis is a serious and potentially fatal complication, requiring immediate and effective management. The advent of the specific antagonist, sugammadex, has widely spread its use because it reduces the incidence of residual neuromuscular blockade and is indicated in the protocol for the treatment and reversal of refractory anaphylaxis. This study reports an episode of anaphylaxis induced by rocuronium and successfully reversed after administration of sugammadex. CASE REPORT: A 6-year-old child, weighing 30 kg, scheduled for video-assisted thoracoscopy under general anesthesia presented with tachycardia, severe hypotension, and diffuse skin rash after induction of general anesthesia and administration of rocuronium. All therapeutic measures were immediately taken for the treatment of a severe allergic reaction, however there was no clinical improvement, and the patient progressed to sinus bradycardia. At this point, cardiopulmonary resuscitation maneuvers were initiated, and adrenaline was administered, but without satisfactory clinical response. In this context, the possibility of the causative agent being rocuronium was raised. Sugammadex was administered 16mg/kg, and the patient immediately returned to sinus rhythm and later presented a favorable clinical evolution and no sequelae. DISCUSSION: Sugammadex is a molecule that encapsulates rocuronium and removes it from both plasma and neuromuscular junction, and then excretes it inertly in the urine. Some authors suggest that sugammadex removes rocuronium molecules from the circulation, whether free or IgE-bound. This mechanism is extremely important, especially in grade III and IV anaphylactic reactions, which can lead to death. In view of the scarcity of publications, this report showed the role of sugammadex in the reversal of rocuronium-induced anaphylaxis, refractory to conventional treatment.

Knowledge, attitude, practice, and associated factors of health professionals towards cardiopulmonary resuscitation at Ayder Comprehensive Specialized Hospital, 2023, Tigray, Ethiopia.

Cardiopulmonary resuscitation (CPR) is a crucial medical technique that is performed manually to preserve intact brain function. Early initiation of CPR manoeuvres and activation of the chain of survival are key factors in the prognosis of patients with cardiorespiratory arrest (CRA). Inadequacy in any step of CPR due to a lack of knowledge or skill is associated with a poor return of spontaneous circulation and a decreased survival rate. To assess the knowledge, attitude, practice, and factors associated with health towards CPR at Ayder Comprehensive Specialized Hospital 2023. Institution-based cross-sectional study was conducted to assess the knowledge, attitude, and practice of health professionals towards cardiopulmonary CPR in Ayder Comprehensive Specialized Hospital Of Tigray, Ethiopia from 1 May to 30 August 2023. Data were collected using structured questionnaires by Two BSC anaesthesia staff and One MSc. as supervisor. A stratified random sampling technique was used to select the study participants. The Data were entered and analyzed using SPSS version 23. Variables with P value less than 0.20 were fitted into multivariate logistic regression. Descriptive statistics such as frequencies, median, interquartile range, percentages, tables, graphs and charts were used to present the results. A total of 262 Of 277 healthcare providers were included in the study, with a response rate of 93.3%. Knowledge, attitude, practice of health professionals towards CPR was 22.5%, 39% and 31.5%, respectively. MSc degree in level of education [adjusted odds ratio (AOR): 8.561 95% CI=2.109-34.746], CPR training (AOR: 2.157, 95%, 1.005, 4.631), and Work experience 6-10years and more than 10 (AOR =0.195, 95% CI, 0.071-0.539) and AOR =0.148 195 95% CI, 0.017, 1.285) were significantly associated with knowledge. The Anaesthetist and Medical doctors were 5.5 times (AOR, 5.50, 95% CI 1.263-23.93) and 2.125 times (AOR: 2.125, 95% CI, 0.865-5.216) respectively more likely to have favourable attitude than the midwives. Regarding to practice participants with CPR training (AOR: 1.804 95% CI=0.925-3.518), good knowledge (AOR: 2.766 95% CI=1.312-5.836) and favourable attitude (AOR: 1.931, 95% CI=0.995-3.749) were significantly associated with safe practice. The overall level of health professionals, knowledge, attitude, practices, and factors associated towards CPR in Ayder Comprehensive Specialized Hospital at Tigray, Ethiopia were insufficient, favourable and safe enough. Regular CPR training is recommended to increase the knowledge, attitude, and practice of healthcare professionals towards CPR.

Physiological and performance metrics during a cardiopulmonary real-time feedback simulation to estimate cognitive load

Multitasking is crucial for First Responders (FRs) in emergency scenarios, enabling them to prioritize and treat victims efficiently. However, research on multitasking and its impact on rescue operations are limited. This study explores the relationship between multitasking, working memory, and the performance of chest compressions during cardiopulmonary resuscitation (CPR). In this experiment, eighteen first-year residents participated in a CPR maneuver using a real-time feedback simulator to learn chest compressions. Different additional secondary tasks were developed and accomplished concurrently with the chest compressions. Heart rate, respiration rate, galvanic skin response, body temperature, eye gaze movements and chest compression performance data were collected. The findings of this study indicated that multitasking impacted chest compression quality for all secondary tasks, showing significance (p-value < 0.05) for the frequency of the chest compressions which worsened in all cases. Additionally, vital signs such as heart rate, respiration rate, and eye gaze speed were also affected during multitasking. Nevertheless, this change on vital signs was different depending on the type of secondary task accomplished. Therefore, as a conclusion, performing multiple tasks during chest compressions affects performance. Understanding cognitive load and its impact on vital signs can aid in training FRs to handle complex scenarios efficiently.

Implementation of a Smart Teaching and Assessment System for High-Quality Cardiopulmonary Resuscitation.

The purpose of this study is to develop a smart training and assessment system called SmartCPR, for teaching and training cardiopulmonary resuscitation (CPR), based on human posture estimation techniques. In this system, trainees can automatically recognize and evaluate whether chest compressions during CPR meet the standard of high-quality CPR by simply using a device such as a smart phone. Through the system, trainees are able to obtain real-time feedback on the quality of compressions so that they can adjust the cycle, depth, frequency, and posture of compressions to meet the standard of high-quality CPR. In addition, the SmartCPR system is convenient for CPR trainers. Trainers can instantly and accurately assess whether the trainee's compressions meet the standard of high-quality CPR, which reduces the risk of manual assessment errors and also reduces the trainer's teaching pressures. Therefore, the SmartCPR system developed in this study can be an important tool for CPR teaching and training for physicians, which can provide training and guidance for high-quality CPR maneuvers and enable trainees to become more proficient in CPR and self-training.

Characterization and mid-term outcomes of current out-of-hospital cardiac arrest patients admitted to intensive cardiovascular care units

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Consell Català de Resuscitació. Background Out-of-hospital cardiac arrest (OHCA) accounts the 50% of cardiovascular deaths. Being aware of characteristics and outcomes of our OHCA population is important in order to apply measures in the weaker areas to improve the results of the process. Purpose To investigate current outcomes, at 6-month follow-up, of patients admitted to an Intensive Cardiac Care Unit (ICCU) in a mediterranean area during the 2020s. Current characteristics, prehospital management and factors related to outcomes were also analyzed. Methods PCR-Cat was a prospective observational multicentre registry. OHCA patients admitted to the ICCU of 8 hospitals were included from October/2020 to December/2021. Those who survived with good neurological status, no disabilities, and remained independent for usual life activities, were classified as Good Outcome (GO). Those patients who died or had a poor neurological status, with high dependency or rested in permanent vegetative status were classified as Poor Outcome (PO). A multinomial logistic regression was done to analyze the factors independently related to PO. Results 288 patients were included, only 50 (17.36%) were women. At 6-month follow-up, 48.95% of patients had GO. Most events happened in the first month (Figure 1). The cause of death was neurological in 72.9%. Patients with PO were significantly older (63.74 vs. 58.88, p=0.003) and had more comorbidities (Table 1A). The most frequent location was on a public space (54.84%) and most were witnessed (88.93%). Cardiopulmonary resuscitation maneuvers were initiated by a bystander in 69.18% until EMS arrival, being only 20.79% done by an experienced bystander. The medium no-flow time was low (2 min) but total time until ROSC was of 28 min. First rhythm was shockable in 80%, but an automatic external defibrillator was only used in 58% of cases. Statistically significant lower values of first pH and higher values of first lactate, glucose and creatinine were related to PO (Table 1B). Patients with PO had a higher APACHE II (26 vs. 20, p&amp;lt;0.001) and SOFA (10.39 vs. 7.14, p&amp;lt;0.001) scores at admission, and required a longer time on mechanical ventilation (6 vs. 3.5 days, p=0.001). The main cause of the OHCA was acute coronary syndrome (53.82%), followed by chronic coronary syndrome (7.64%) and dilated myocardiopathy (7.64%). In the multinomial logistic regression, older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), longer ROSC time (p&amp;lt;0.001) and non-shockable first rhythm (p&amp;lt;0.001) were independently related to PO. Receiving cardiopulmonary resuscitation maneuvers by an experienced bystander was related to a reduction of 17 min of ROSC (p=0.001). Conclusions Less than a half of patients admitted to an ICCU because of an OHCA had GO at 6-month follow-up. Age, male sex, previous stroke, longer ROSC time and non-shockable first rhythm were factors independently related to PO. Interventions addressed to reduce ROSC time are urgently needed.

Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study in Japan.

International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000. From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups. Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes. URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.

Desarrollo validación y evaluación de la prueba de conocimientos sobre reanimación cardiopulmonar y uso correcto del desfibrilador externo automático en Asunción 2023

Introduction: in out-of-hospital cardiac arrest, early and efficient intervention through cardiopulmonary resuscitation (CPR) maneuvers and the use of the automated external defibrillator (AED) are the cornerstone for survival. Instruments that improve education would increase the responsiveness of lay personnel. Objectives: to develop, validate and evaluate a knowledge test on cardiopulmonary resuscitation and correct use of the automated external defibrillator in Asunción during 2023. Methodology: observational cross-sectional study, non-probabilistic sample for convenience of lay personnel users of mass attendance centers in Asunción. An exclusive questionnaire was developed on knowledge in cardiopulmonary resuscitation and the use of the automated external defibrillator (KOR-AED) based on the chain of survival in out-of-hospital cardiac arrest. Content, construct, and internal consistency were validated using expert opinion, factor analysis and Cronbach's alpha. Results: a total of 200 lay people participated, mostly shopping mall customers, with a predominance of men (63.5 %) (127), between 25-29 years old 28.5% (57). 61.5 % (123) had a university education, 75.5 % (151) had not related to health, 52 % (104) had prior knowledge of CPR, but 81.5 % (163) did not. The test showed reliability and suitability for factor analysis (Cronbach's alpha 0.75, Kaiser-Meyers-Olkin; 0.78, Bartlett p&lt;0.05). The questions covered the first three links in the chain of survival, with items of medium to high difficulty. Women performed significantly better (p=0.04). Conclusion: the KOR-AED test is a valid and reliable instrument to improve the education of the layperson in CPR and use of the AED based on the chain of survival.

Cardiopulmonary resuscitation: the power to save lives

Cardiopulmonary arrest (CPA) is understood as the sudden, unexpected and catastrophic cessation of systemic circulation, useful ventricular and ventilatory activity. It is essential that any individual is aware of the risk factors, epidemiology, has minimal knowledge to recognize a CPA early and can proceed appropriately to provide quality support to the victim. The advances in terms of technology, treatment and prevention are notorious, however, many lives are still lost due to the poor quality of a first care. The study aimed to understand the level of knowledge and train the population about risk factors, epidemiology, early recognition, correct initial approach, cardiac compressions and quality ventilation, in order to reduce the incidence of mortality and improve the prognosis of patients in cardiac arrest. An exploratory intervention was used, bringing knowledge objectively, through banners, folders and lectures in easy-to-understand language, providing quality and relevant information so that listeners could acquire indispensable skills and actually change lives. The actions took place in a Basic Health Unit (BHU), on previously established days and times, always striving to reach as many people as possible. Recognizing early and knowing how to conduct a CPA until specialized help arrives is of fundamental importance, but unfortunately the largest part of the population approached demonstrated to be unaware of the basics on the subject. Unpreparedness regarding risk factors, initial signs and symptoms and, mainly, regarding the initial approach and effective cardiac compressions, was present in most of the target audience. Urgent and emergency situations can result in serious clinical outcomes, sequels and even death of the victims. A trained layperson, capable of identifying and carrying out the necessary actions, can considerably improve the prognosis of victims who are in an urgent or emergency situation in society. It is important to provide quality and effective care, so that the victims do not have sequelae or, if they do, that these are minimal. Fast and efficient help is essential to avoid irreversible neurological damage, in addition to the risk of death that increases every minute. For this, it is necessary to start Cardiopulmonary Resuscitation (CPR) maneuvers as early as possible, even by a person who is not in the health area until specialized help arrives. In view of the results obtained, it is concluded that training on basic life support in cardiac arrest is still a little-known topic among the public addressed, which reflects a common scenario among the lay population and reinforces the importance of carrying out studies such as this in society, in order to disseminate basic knowledge that saves lives. It is essential that cardiopulmonary resuscitation training is not something exclusive to health professionals, the lay population needs to be guided so that they know how to act correctly in critical moments. The activities carried out spread health knowledge and provided subsidy so that the part of the contemplated population can also act as health educators.

Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study

IntroductionDrowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR. MethodsA quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway). ResultsThe quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques. ConclusionThe rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.

The effect of thoracic dimensions on compression depth during cardiopulmonary resuscitation.

The effect of the dimensions of the thoracic cage on the resuscitation outcome of cardiopulmonary resuscitation (CPR) maneuvers has long been debated. In this study, the effect of changes in the rib cage dimensions on the achieved compression depth was investigated using finite element simulations. A total of 216 different rib cage geometry models were considered and, in each case, the result of applying different levels of compression force up to 600 N were simulated. The Haller Index of the rib cage is defined as the ratio of the transverse diameter and the antero-posterior diameter. Our results suggest that, with a fixed level of compression force, performing CPR on rib cages having a low Haller Index and/or a larger height leads to compression depths below the average. Alternatively, if a target compression depth is set for CPR, in general a lower compression force would be required for individuals with higher Haller Index and/or lower chest height. In addition, present results indicate that wider chested individuals will experience lower stress levels on their ribs to achieve the required CPR target depth. Moreover, in the present study we propose predictive models, based on anthropometric parameters, for compression depth and rib stress during chest compressions. In particular, the model suggests that in future correlations of empirical CPR data the patients' Haller index and vertical (sagittal) cross-area are the best parameters to be used as independent variables in a fit.

Systematic basic and advanced resuscitation training in medical students and fellows: a proposal from the Working Group on Cardiovascular Urgences and Emergencies of the Italian Society of Cardiology.

Sudden cardiac arrest is a leading cause of death in Europe. High-quality cardiopulmonary resuscitation (CPR) and guidelines compliance of rescuers have been associated with better outcomes after cardiac arrest. However, wide variability in attempting bystander CPR manoeuvres has been reported. Educational programmes for teaching CPR to medical students and fellows are highly advisable in this context. However, there is no homogeneity regarding the CPR education offered by academic institutions. We surveyed 208 Italian medical students and 162 fellows in cardiology regarding the educational offer and needs in CPR. Among the 11 medical schools surveyed, 8 (73%) offer basic (BLS) courses but only 3 (38%) with formal certification of 'BLS provider', while none offers advanced (ACLS/ALS) courses. Among the 30 specialization schools in cardiology surveyed, 10 (33%) offer a BLS course (6 with formal certification of 'BLS provider'), and 8 (27%) offer an ACLS/ALS course (5 with formal certification). Only a minority of students and fellows perceive themselves as highly proficient either in BLS or ACLS/ALS, although most of the fellows were involved at least once in rescuing a cardiac arrest. The present position paper analyses and suggests the strategies that should be adopted by Italian medical and specialization schools to spread the CPR culture and increase the long-standing retention of CPR-related technical and nontechnical skills.

Hypertonic sodium lactate infusion reduces vasopressor requirements and biomarkers of brain and cardiac injury after experimental cardiac arrest

IntroductionPrognosis after resuscitation from cardiac arrest (CA) remains poor, with high morbidity and mortality as a result of extensive cardiac and brain injury and lack of effective treatments. Hypertonic sodium lactate (HSL) may be beneficial after CA by buffering severe metabolic acidosis, increasing brain perfusion and cardiac performance, reducing cerebral swelling, and serving as an alternative energetic cellular substrate. The aim of this study was to test the effects of HSL infusion on brain and cardiac injury in an experimental model of CA.MethodsAfter a 10-min electrically induced CA followed by 5 min of cardiopulmonary resuscitation maneuvers, adult swine (n = 35) were randomly assigned to receive either balanced crystalloid (controls, n = 11) or HSL infusion started during cardiopulmonary resuscitation (CPR, Intra-arrest, n = 12) or after return of spontaneous circulation (Post-ROSC, n = 11) for the subsequent 12 h. In all animals, extensive multimodal neurological and cardiovascular monitoring was implemented. All animals were treated with targeted temperature management at 34 °C.ResultsThirty-four of the 35 (97.1%) animals achieved ROSC; one animal in the Intra-arrest group died before completing the observation period. Arterial pH, lactate and sodium concentrations, and plasma osmolarity were higher in HSL-treated animals than in controls (p < 0.001), whereas potassium concentrations were lower (p = 0.004). Intra-arrest and Post-ROSC HSL infusion improved hemodynamic status compared to controls, as shown by reduced vasopressor requirements to maintain a mean arterial pressure target > 65 mmHg (p = 0.005 for interaction; p = 0.01 for groups). Moreover, plasma troponin I and glial fibrillary acid protein (GFAP) concentrations were lower in HSL-treated groups at several time-points than in controls.ConclusionsIn this experimental CA model, HSL infusion was associated with reduced vasopressor requirements and decreased plasma concentrations of measured biomarkers of cardiac and cerebral injury.

Percepción de los estudiantes de pregrado de medicina frente a la tasa de éxito de la reanimación cardiopulmonar:

Introduction: According to the American Heart Association, the survival rate after cardiopulmonary resuscitation (CPR) performed at a hospital is 25.8%. In both medical staff and the general population, multiple factors cause an overestimation of the effectiveness of CPR maneuvers. Methods: Observational cross-sectional study. Through an online survey, the perception of medical students about the survival rate after receiving CPR in an in-hospital setting was inquired. Additionally, it was asked if they would accept CPR in case of presenting a cardiac arrest. Participants were then informed of the actual survival rates and asked again if they would accept receiving CPR. Results: 692 students were surveyed (78.9% of the target population). 61% of the participants stated that the survival rate after CPR was greater than 30%. Before knowing the actual survival rates, 95.5% would accept CPR maneuvers, and after knowing the actual survival rates, only 75.3% would accept them. Discussion: The results confirmed that the perception of the survival rate after in-hospital CPR maneuvers is overestimated by medical students. This could affect their medical criteria and shared decision-making process with patients. Additionally, having adequate information about the result of an intervention changes the decision towards receiving it or not.

The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation.

A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

Post-Cardiac Arrest: Mechanisms, Management, and Future Perspectives.

Cardiac arrest is an important public health issue, with a survival rate of approximately 15 to 22%. A great proportion of these deaths occur after resuscitation due to post-cardiac arrest syndrome, which is characterized by the ischemia-reperfusion injury that affects the role body. Understanding physiopathology is mandatory to discover new treatment strategies and obtain better results. Besides improvements in cardiopulmonary resuscitation maneuvers, the great increase in survival rates observed in recent decades is due to new approaches to post-cardiac arrest care. In this review, we will discuss physiopathology, etiologies, and post-resuscitation care, emphasizing targeted temperature management, early coronary angiography, and rehabilitation.

Abstract 14112: " Leave My Tongue Alone :" Is the Myth of Tongue Swallowing Still Preventing Proper Cardiopulmonary Resuscitation Efforts of Athletes With Cardiac Arrest?

Introduction: In 2017, we reported that during cardiac arrest (CA) events of athletes caught on video, the initial response of fellow teammates and paramedical personnel, is incorrect and disturbing: An attempt to prevent and/or relief "tongue swallowing" takes precedent over chest compression. We aimed to see if our report had any impact on the proper resuscitation of athletes. Methods: We continued our internet search for events of CA or transient loss of consciousness (LOC) severe enough to prompt resuscitation. For each video, we focused on the resuscitation maneuvers performed by fellow athletes. In addition, we reviewed the news coverage of each event, to learn how the resuscitation efforts are described in social media. Results: We expanded our original 29-video-collection to a total of 42 videos and 1 news article, showing athletes collapsing with CA (n=33) or LOC prompting resuscitation (n=10). The athletes with witnessed CA had a mean age of 25 + 4 years and all but one were male. The first intervention was visible in 37 videos and in 83% it was an obvious attempt to prevent "tongue swallowing.” Chest compressions were applied to only 33% of athletes. Media coverage, in 34 lay press articles, portrayed this wrong response as “heroic” in 6 cases. In the rest, the wrong resuscitation maneuvers were neither criticized nor questioned. The phrase “preventing tongue swallowing” appears in 3 articles, all highly publicized (BBC, ESPN etc). When an athlete did not survive following these wrong cardiopulmonary resuscitation manoeuvres, the lay media ignored the erroneous resuscitation. Conclusion The lay-media coverage of CA events of athletes portrays a disturbing reality in which wrong actions by first responders, including the prevention of tongue swallowing, are deemed heroic, while the necessary criticism of these actions is absent.

Fibromuscular Dysplasia of the Coronary Arteries: An Infrequent Cause of Sudden Death

Sudden cardiac death (SCD) is defined as a sudden and unexpected death secondary to a cardiovascular cause. In many cases, cardiopulmonary resuscitation (CPR) maneuvers can achieve recovery of the patient, which is then called resuscitated SCD. We present the case of an adolescent with resuscitated SCD, who finally died of refractory cardiogenic shock, secondary to fibromuscular dysplasia of the coronary arteries.

Biomechanical response of human rib cage to cardiopulmonary resuscitation maneuvers: Effects of the compression location.

The biomechanical response of a human rib cage to cardiopulmonary resuscitation maneuvers was investigated by means of finite element simulations. We analyzed the effect of the location where the force was applied on the achieved compression depths and stress levels experienced by the breastbone and ribs. For compression locations on the breastbone, a caudal shift of the application area toward the breastbone tip resulted in a 17% reduction of the force required to achieve a target 5 cm compression depth. We found that the use of compression regions located on the costal cartilages would involve higher risk of rib fractures.

Operative versus non-operative management of rib fractures in flail chest after cardiopulmonary resuscitation manoeuvres.

OBJECTIVESBlunt chest trauma after mechanical resuscitation manoeuvres appears to have a significant impact on the often complicated course. Due to a lack of data in the literature, the purpose of this study was to investigate the feasibility and immediate outcome of chest wall stabilization for flail chest in this vulnerable patient population.METHODSWe retrospectively reviewed the medical records of patients after cardiopulmonary resuscitation between January 2014 and December 2018 who were diagnosed with flail chest. We attempted to compare patients after surgery with those after conservative treatment.RESULTSOf a total of 56 patients with blunt chest trauma after mechanical resuscitation and after coronary angiography, 25 were diagnosed with flail chest. After the exclusion of 2 patients because of an initial decision to palliate, 13 patients after surgical stabilization could be compared with 10 patients after conservative therapy. Although there was no significant difference in the total duration of ventilatory support, there was a significant advantage when the time after stabilization to extubation was compared with the duration of ventilation in the conservative group. The presence of pulmonary contusion, poor Glasgow Coma Scale score or the development of pneumonia negatively affected the outcome, but additional sternal fracture did not.CONCLUSIONSSurgical stabilization for chest wall instability is well tolerated even by this vulnerable patient population. Our results should be used for further randomized controlled approaches. It is necessary to evaluate the situation with all parameters in an interdisciplinary manner and to decide on a possible surgical therapy at an early stage if possible.