Cardiopulmonary Resuscitation Methods Research Articles

Efficacy of mechanical against manual method in cardiopulmonary resuscitation for out‑of‑hospital cardiac arrest: A meta‑analysis.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality worldwide, with the efficacy of cardiopulmonary resuscitation (CPR) methods playing a crucial role in patient outcomes. The present study aimed to compare the effectiveness of mechanical and manual CPR in OHCA, focusing on three outcomes: Return of spontaneous circulation (ROSC), survival to admission and survival till discharge. A comprehensive meta-analysis was conducted, incorporating 39 studies for ROSC, 28 for survival to admission, and 30 for survival till discharge, totalling 144,430, 130,499 and 162,088 participants, respectively. The quality of evidence was evaluated using the GRADE approach, assessing risk of bias, inconsistency, indirectness, imprecision and publication bias. Statistical analysis included pooled odds ratios (ORs) with 95% confidence intervals (CIs) and sensitivity analyses. For ROSC, the pooled OR was 1.09 (95% CI: 0.92-1.29), demonstrating no significant difference between mechanical and manual CPR. Survival to admission favoured mechanical CPR with a pooled OR of 1.25 (95% CI: 1.09-1.43). No conclusive difference was found for survival till discharge, with a pooled OR of 0.79 (95% CI: 0.61-1.02). Substantial heterogeneity was observed across outcomes. Evidence of potential publication bias was noted, particularly in the survival to admission outcome. The overall quality of evidence was graded as very low, mainly due to high heterogeneity and indirectness of evidence. The study suggests that mechanical CPR may improve short-term outcomes such as survival to admission in patients with OHCA but does not demonstrate a significant long-term survival benefit over manual CPR.

Systematic review of swine models for ventricular fibrillation induction in evaluating cardiopulmonary resuscitation methods

Background and purpose: Ventricular fibrillation (VF) has been studied using a variety of swine models, historically balloon occlusion of the coronary artery and asphyxiation, and more recently, percutaneous electrical induction. These methods differ in face and construct validity, as well as requirement for expertise, cost, and duration. This study aimed to provide a systematic review these methods and their selection in research. Methods: Electronic searches were conducted in PubMed, Scopus, and Google Scholar. The Utstein-Style Guidelines for Uniform Reporting of Laboratory cardiopulmonary resuscitation (CPR) research were used to identify the extracted variables by two independent investigators. Discrepancy was resolved by discussion with the third investigator. Results: We included 236 studies published from 1990 to 2024. The most commonly used method was electrical induction using a pacing wire cannulated through the external jugular vein into the right ventricle (n = 112), followed by transthoracic electrical induction (n = 28), asphyxiation (n = 20), electrical induction via two subcutaneous needles (n = 15), and balloon occlusion (n = 10). The mean and standard deviation (SD) of the untreated VF duration were 6.9 and 5.0 minutes, respectively. Female and male pigs were used exclusively in 52 and 45 studies, respectively; both sexes were used in 31 studies; 106 studies not reporting the sex. The mean weight of the pigs was 30.2 ± 12.4 kg in 209 studies, and the number of pigs used in the studies ranged from 2 to 271 with a median of 20 (interquartile range: 15–30) pigs in 223 studies. The four most commonly used drugs for anesthesia/preparation were ketamine (n = 145), propofol (n = 76), isoflurane (n = 68), and pentobarbital (n = 61), either alone or in combination. Higher current and voltage were used for less invasive methods. Conclusions: The two most common electric method to induce VF were invasive pacing at the right ventricle and non-invasive transthoracic electrical induction. Asphyxiation was the most common ischemic VF induction. The choice of the VF induction method depends on cost, expertise, feasibility, and the nature of the CPR intervention to be tested.

Abstract 185: Regional Oxygen Saturation and Capnography Monitoring During Resuscitation After Cardiac Arrest in a Swine Pediatric ARDS Model

Introduction: Survival and outcomes after cardiac arrest (CA) depend largely on the effectiveness of cardiopulmonary resuscitation (CPR). Traditional invasive methods of monitoring CPR can be challenging out-of-hospital and are lacking in more than 50% of in-hospital pediatric CA. Regional oxygen saturation (rSO 2 ) monitoring with Near Infrared Spectroscopy (NIRS) and volumetric capnography offers a noninvasive approach that could potentially overcome these challenges. Aim: To determine the feasibility and effectiveness of NIRS and volumetric capnography monitoring in a swine model of pediatric hypoxia induced CA. Approach: Juvenile pigs were sedated and mechanically ventilated. Mild to moderate Acute Respiratory Distress Syndrome (ARDS) was induced by continuous oleic acid infusion. Respiratory and hemodynamic variables were monitored using invasive and noninvasive (NIRS and capnography) monitoring to assess efficacy of CPR. Animals were randomized into one of the two groups: High-quality CPR (hqCPR) to achieve coronary perfusion pressure of 25-30 mmHg and low-quality CPR (lqCPR) to achieve coronary perfusion pressure of 10-15 mmHg. Trajectories over time were analyzed using regression analyses. The discriminatory ability to distinguish between groups based on trajectories were analyzed using receiver operating characteristics curve (ROC) analysis. Results: 39 animals (23±3 kg) were included in our study. In the hqCPR group, there are generally higher values for cerebral and renal rSO 2 , ETCO 2 , volume of CO 2 elimination (VCO 2 ), and carotid blood flow, compared to the lqCPR group (p<0.0001). Cerebral and renal rSO 2 values increase over time, while ETCO 2 , VCO 2 , and carotid flow values decrease in the hqCPR group. Cerebral rSO2 had a ROC AUC of 0.76 (95% CI: 0.58-0.94), whereas renal rSO2 had a ROC AUC of 0.54 (95% CI: 0.22-0.87) representing nearly no discrimination ability. ETCO 2 had a ROC AUC of 0.66 (95% CI: 0.49-0.84), whereas VCO 2 had a ROC AUC of 0.62 (95% CI: 0.38-0.85). Conclusions: Higher mean cerebral rSO2 values during CPR might be used to assess quality of CPR effectiveness and provide real-time adjustments as needed. This could guide healthcare providers in optimizing CPR quality and improving outcomes for cardiac arrest patients.

Meta-analysis of chest compression-only versus conventional cardiopulmonary resuscitation by bystanders for adult with out-of-hospital cardiac arrest.

According to the guidelines of cardiopulmonary resuscitation (CPR) conducted by bystanders, two methods of CPR are feasible: standard CPR (sCPR) with mouth-to-mouth ventilations and continuous chest compression-only CPR (CCC) without rescue breathing. The goal herein, was to evaluate the effect of sCPR (30:2) and CCC on resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA) patients. This study was a systematic review and meta-analysis. Using standardized criteria, Pub- Med, Web of Science, Scopus, EMBASE and Cochrane Collaboration were searched for trials assessing the effect of sCPR vs. CCC on resuscitation outcomes after adult OHCA. Random-effects model meta-analysis was applied to calculate the mean deviation (MD), odds ratio (OR) and 95% confidence interval (CI). Overall, 3 randomized controlled trials and 12 non-randomized trials met the inclusion criteria. Survival to hospital discharge with sCPR was 10.2% compared to 9.3% in the CCC group (OR = 1.04; 95% CI: 0.93-1.16; p = 0.46). Survival to hospital discharge with good neurological outcome measured with the cerebral performance category (CPC 1 or 2) was 6.5% for sCPR vs. 5.8% for CCC (OR = 1.00; 95% CI: 0.84-1.20; p = 0.98). Prehospital return of spontaneous circulation (ROSC) in sCPR and CCC groups was 15.9% and 14.8%, respectively (OR = 1.13; 95% CI: 0.91-1.39; p = 0.26). Survival to hospital admission with ROSC occurred in 29.5% of the sCPR group compared to 28.4% in CCC group (OR = 1.20; 95% CI: 0.89-1.63; p = 0.24). This systematic review and meta-analysis concluded that there were no significant differences in the resuscitation outcomes between the use of standard cardiopulmonary resuscitation and chest compression only.

Evaluation of the efficiency of the different methods of teaching cardiopulmonary resuscitation to children and adolescents: integrative review

Objective: To evaluate the efficiency of different teaching methods of Basic Life Support for lay students from 12 years of age. Methods: A search was carried out for articles on the MEDLINE/PubMed and Lilacs/BVS platforms between December 2021 and January 2022 to answer the guiding question, "How effective are the different teaching methods of cardiopulmonary resuscitation for children and adolescents?". Articles published in English and Portuguese in the last five years were included. Results: Seven articles addressed teaching methods: self-regulated learning, training of teachers followed by students, peer education, online teaching associated with practical self-training, distance learning, digital training added to practice, and application use through a tablet with subsequent evaluation. In all studies, there was a comparison between intervention and conventional training. In general, all teaching methods contributed to developing the ability to act in trauma situations, but strategies that involved the presence of instructors in training showed better short- and long-term results. Conclusion: this study verified the findings in the literature regarding the effectiveness of different BLS teaching methods for children and adolescents. Among all approaches, better performance was observed in methods that had the presence of instructors, who offered feedback to students and reduced distractions. However, digital, self-regulated, and peer teaching also proved viable. Therefore, the choice of method should be based on the target audience's reality.

First attempt success with continued versus paused chest compressions during cardiac arrest in the emergency department

AimTracheal intubation is associated with interruption in cardiopulmonary resuscitation (CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital environment. We aim to describe characteristics of tracheal intubation during active CPR in the emergency department (ED) and determine whether first attempt success was associated with CPR being continued vs paused. MeasurementsWe reviewed overhead video from adult ED patients receiving chest compressions at the start of the orotracheal intubation attempt. We recorded procedural detail including method of CPR, whether CPR was continued vs paused, and first attempt intubation success (primary outcome). We performed logistic regression to determine whether continuing CPR was associated with first attempt success. ResultsWe reviewed 169 instances of tracheal intubation, including 143 patients with continued CPR and 26 patients with paused CPR. Those with paused CPR were more likely to be receiving manual rather than mechanical chest compressions. Video laryngoscopy and bougie use were common. First attempt success was higher in the continued CPR group (87%, 95% CI 81% to 92%) than the interrupted CPR group (65%, 95% CI 44% to 83%, difference 22% [95% CI 3% to 41%]). The multivariable model demonstrated an adjusted odds ratio of 0.67 (95% CI 0.17 to 2.60) for first attempt intubation success when CPR was interrupted vs continued. ConclusionsIt was common to continue CPR during tracheal intubation, with success comparable to that achieved in patients without cardiac arrest. It is reasonable to attempt tracheal intubation without interrupting CPR, pausing only if necessary.

160 CARDIOPULMONARY RESUSCITATION IN MICROGRAVITY

Abstract Introduction The increase of human space missions in microgravity conditions has led the scientific community to investigate the potential effects on astronauts' bodies. There is a high incidence of cardiovascular complications, with cardiac arrest being among the most difficult to manage. On earth, guidelines regarding cardiopulmonary resuscitation are constantly updated; however, in microgravity, the literature on the subject is still lacking. The aim of this study is to review the available literature and lay the foundation for further nursing developments in this regard. Materials and Methods A literature review was conducted by consulting Pubmed as the database. The research question was, "How is CPR performed on the astronaut suffering from cardiac arrest during space flight?" As inclusion criteria, we considered all relevant studies in the literature in the last 10 years, using MeSH terms. Results and Discussion The studies reviewed showed that there are 5 possible methods of cardiopulmonary resuscitation in the space environment (Consensus of 2015) : the Reverse Bear Hug Method; the Side-Straps Method; the Evetts-Russomano Method; the Handstand Method; and the Waist Straddle Method. Mackaill et all, through a simulation on a parabolic flight, a dummy and 10 different operators, demonstrated that the Russomano maneuver is capable of sustaining the cardiac circulation by conferring effective manual chest compressions. Hinkelbein et all, drafted a first guideline regarding resuscitation maneuvers. The results of the study also show that defibrillation and ventilation appear to be techniques that have not yet been investigated. The belief remains that BLSD and ALS protocols can be applied in the same manner as applied on Earth. Schimtz et all, with an RCT study that included 15 volunteers and a simulation dummy placed underwater (an environment similar to space characteristics), studied 2 different resuscitation techniques, comparing the Schimtz-Hinkelbein Method and the Cologne Method. The former method demonstrated a better depth and frequency of repetitions of manual compressions. Subsequently, Forti and his collaborators, highlighted the application of automatic mechanical compression devices generating effective compressions. Conclusion To date there is little evidence to state with certainty that exclusively one method of cardiopulmonary resuscitation is effective in the aerospace environment. Since the emergency of cardiac arrest is a major problem there is a need to study these processes more thoroughly and entrust health care professionals with the management, practice and theory of such space dynamics also in view of the arrival of the nursing presence during missions in space.

A Study to assess the effectiveness of Video Assisted Teaching regarding the knowledge of Cardio Pulmonary Resuscitation among B.Sc. 2nd year students, Ambikapur, Chhattisgarh

Introduction Sudden death occur when heartbeat and breathing stop suddenly or unexpectedly. The major role pf CPR is to provide oxygen to heart, brain and the other vital organ until medical treatment (advance cardiac life support-ACLS) can restore normal heart action. Angela Morrow RN cardiopulmonary resuscitation (CPR) is a procedure used when a patient’s heart stops compressions of the chest or electrical shocks along with rescue breathing. Mosby Medical Dictionary CPR is basic emergency procedure for life support consisting of artificial and manual external cardiac massage. There were some techniques to keep people alive developed in the 18th century, both in Japan and in Europe, but it was well into the 20th century before Elam and Safar discovered and published the truly effective method known as CPR. Safar conducted research on existing basic life support procedure including controlling a person's breathing airway by tilting back his or her head with an open mouth; and using mouth to mouth breathing. He combined these with a procedure known as closed-chest cardiac massage to become and basic life support method of CPR. Safar also created the first guidelines for community-wide emergency medical Services, or EMS; he founded the International Resuscitation Research Centre at the University of Pittsburgh, which he directed until 1994; and he was nominated three times for a Nobel Prize. Method According to Polit and Hungler - purposive sampling is a type of non probability sampling method in which the Researcher select the subjects for the study on the basis of personal judgement about which one will be most representative or productive. Sampling is the process of selecting a portion of the population to represent the entire population. In which study the purposive sampling technique was used to collect the data from the available samples falling under inclusive criteria. Result and conclusion Pretest knowledge score among B.Sc. nursing 2nd year students of experimental group are 7(14%) having inadequate knowledge. 43 (86℅) having moderate knowledge and none of them are 0(0%) having adequate knowledge. With mean 9.64. mean percentage 15.68% and standard deviation 5.346 respectively. Post test knowledge score among B.Sc. nursing 2nd year student are having inadequate knowledge 2(4%) and B.Sc. nursing 2near student are having moderate knowledge 13(26%) and none of them are having adequate knowledge 35(70%).The B.Sc. nursing 2nd year student score mean of 17.06 mean percentage 44.12% and standard deviation 9.5628 in the level of knowledge assessment.Age of B.Sc. nursing 2nd year students 44% (22) are belongs to 18-19 year of age group 44% (22) B.Sc.2nd year student belongs to 20-21 years of age groups. Religion of B.Sc. nursing 2"year student reveals that 70% (35) B.Sc. nursing are belongs to Hindu religion and 28% (14) B.Sc. nursing 2nd year student belongs to Christian religion, and 2%(1) B.Sc. nursing 2nd year student belong to Muslim. A source of information reveals that 6% (3) B.Sc. nursing 2nd year students gain knowledge through magazine. 2% (1) B.Sc. nursing 2nd year students gain knowledge through newspaper, 18% (9) gain knowledge through T.V.,74% (35) gain knowledge through others. Shows the responses of B.Sc. nursing 2nd year students on structured knowledge questionnaire which is consist of 20 items and under four areas. This area comes under pre test knowledge. First areas mean score is 3.1, mean percentage is 2.6, SD 1.3153. second areas mean score 1.22, mean percentage 2.44, SD 0.3450. third areas mean score1.64, mean 3.28. SD 0.0028. fourth areas mean score 3.68, mean 7.36, SD 3.6430, Overall pretest result are mean (9.64), mean (15.68), SD(5.3461). This area comes under post test knowledge. first areas mean score is 4.88, mean percentage is 9.76, SD 2.0705. second areas mean score 3.7, mean percentage 7.4, SD 1.0465. third areas mean score 1.98, mean 13.96, SD 0.0098. Fourth areas mean score 6.5. mean 13, SD 6436, Overall posttest result are mean (17.06), mean o. (44.I2), SD (9.5628). Difference mean % of the pre test and post test knowledge score are: - first areas mean %7 second areas mean % 4.96, third areas mean 10.68. Fourth areas 5.64 and overall difference mean % 28.28. Reveals that the mean pretest knowledge score was only 9.64 and the post test knowledge score was 17.06. SD 4.21, -paired t value 1.508 and table value 3.365. The paired 't' test was used to find out the effectiveness of between pretest and post test it's shows structured teaching programme on CPR was highly effective at the significance level P (t-1.508).

Abstract 15563: Analysis of the Ventricular Fibrillation Waveform Can Guide Resuscitation in Cardiac Arrest by Identifying the Precipitating Cause and Estimating the Underlying Hemodynamics

Background: Patients presenting with out of hospital cardiac arrest (OHCA) and prolonged (>30 min) cardiopulmonary resuscitation (CPR) face nearly 100% mortality. In patients presenting with ventricular fibrillation (VF), coronary ischemia is thought to be the cause in up to 60%. As conventional CPR does not reverse a coronary ischemia, CPR often must be done until a patient can be brought to a cardiac catheterization laboratory (CCL) where the underlying cause (acute ischemia) can be treated. In a porcine model of cardiac arrest, we have previously demonstrated that machine learning (ML) targeting invasive hemodynamic monitoring, could significantly improve CPR quality. To advance the clinical relevance of the machine-controlled CPR methods, we developed ML algorithms that can diagnose coronary ischemia during VF, and infer the underlying hemodynamics while performing CPR. Methods: In a porcine model of cardiac arrest, VF was induced via high-grade coronary occlusion (ischemia) or electrical stimulation (dysrhythmia). The animals (n = 72) were left in VF for 3 minutes prior to intervention and the ECG waveform was collected. The VF signal was converted to the frequency domain using a fast-fourier transformation and an ensemble classifier was developed to detect underlying ischemia. CPR was then initiated and the VF waveform was continuously monitored along with the coronary perfusion pressure (CPP). We then developed a 20-layer convolutional neural network (CNN) to non-invasively infer the CPP from a 10-second VF waveform. Results: Animal studies were split into training and test sets. When using the developed ML technique to detect ischemia from the VF waveform, evaluation of the test set yielded an area under the curve (AUC) of 0.81 on a ROC. When we used the CNN to infer the underlying hemodynamics, we demonstrated a high correlation between measured and predicted CPP in the test set. The AUC for the ROC when predicting a CPP of >15 mmHg was 0.85. Conclusion: Survival for patients with OHCA secondary to coronary ischemia will improve with rapid diagnosis and high quality CPR. Our results demonstrate the proof-of-concept that the VF waveform contains features that can guide resuscitation for cause identification and hemodynamic improvement.

Retrospective Comparison of Prehospital Sustained Return of Spontaneous Circulation (ROSC) Rates Within a Single Basic Life Support Jurisdiction Using Manual vs Lund University Cardiac Assist System (LUCAS-2) Mechanical Cardiopulmonary Resuscitation.

ObjectiveSeveral studies have examined the impact of mechanical cardiopulmonary resuscitation (CPR) devices among multi-jurisdictional emergency medical services (EMS) systems; however, the variability across such systems can inject bias and confounding variables. We focused our investigation on the effect of introducing the Lund University Cardiac Assist System 2 (LUCAS-2) into a single basic life support (BLS) fire department first response jurisdiction served by a single private advanced life support (ALS) agency, hypothesizing that the implementation of the device would increase prehospital return of spontaneous circulation (ROSC) rates as compared with manual CPR. MethodsA retrospective observational analysis of adult non-traumatic prehospital cardiac arrest ALS agency records was conducted. Descriptive statistics were computed, and logistic regression was used to assess the impact of CPR method, response time, age, gender, CPR initiator, witnessed status, automated external defibrillator (AED) initiator, and presence of an initial shockable rhythm on ROSC rates. A Chi-square analysis was used to compare ROSC rates among compression modalities both before and after the implementation of LUCAS-2 on July 1, 2011. ResultsFrom an initial dataset of 857 cardiac arrest records, only 264 (74 pre-LUCAS period, 190 LUCAS-2 period) met inclusion criteria for the primary objective. The ROSC rates were 29.7% (22/74) and 29.5% (56/190), respectively, for manual-only and LUCAS-assisted CPR (p=0.9673). Logistic regression revealed a significant association between ROSC and two of the independent variables: arrest witnessed (OR 3.104; 95% CI 1.896-5.081; p<0.0001) and initial rhythm shockable (OR 2.785; 95% CI 1.492-5.199; p<0.0013). ConclusionsAnalyses support the null hypothesis that there is no difference in prehospital ROSC rates among adult non-traumatic cardiac arrest patients when comparing mechanical-assisted and manual-only CPR. These results are consistent with other larger multi-jurisdictional mechanical CPR studies. Systems with limited personnel might consider augmenting their resuscitations with a mechanical CPR device, although cost and system design should be factored into the decision. Secondary analysis of independent variables suggests that prehospital cardiac arrest patients with a witnessed arrest or an initial rhythm that is shockable have a higher likelihood of attaining ROSC. The power of our primary objective was limited by the sample size. Additionally, we were not able to adequately assess the quality of CPR among the two comparison groups with a lack of consistent end-tidal carbon dioxide (EtCO2) data.

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity-A Manikin Study.

Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.

Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

BackgroundA favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR.MethodsWe conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge.ResultsAmong 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively.ConclusionsHerein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

Cardiopulmonary Resuscitation Induced Posterior Rib Fractures in Nontraumatic Pediatric Deaths.

Posterior rib fractures are considered suspicious for nonaccidental injury when observed in infants without significant trauma history or underlying bone disease. The biomechanical mechanism postulated for causing posterior rib fractures is anterior/posterior compression of the chest with posterior levering of the rib head over the transverse process of the vertebra creating a focal area of stress. The recommended "2-thumb" cardiopulmonary resuscitation method involves the administrator placing both thumbs on the sternum of the patient, encircling the chest with the hands, and placing the finger tips lateral to the spine. From this position, the administrator compresses the chest in an anterior/posterior direction by pressing on the sternum. Theoretically, the 2-thumb method should focus all force on the sternum while the back is supported by the fingers limiting posterior levering of the ribs and reducing the risk of posterior rib fractures. However, posterior rib fractures have been found during the autopsy of infants who received 2-thumb cardiopulmonary resuscitation, had no traumatic history, had a nontraumatic cause of death, and had no indication of underlying bone disease. This case study series presents the demographics, birth histories, circumstances surrounding death, and autopsy findings of four such medical examiner cases.

Different Resting Methods in Improving Laypersons Hands-Only Cardiopulmonary Resuscitation Quality and Reducing Fatigue: A Randomized Crossover Study

ObjectiveTo determine the effects of different resting methods with various rest-start points or rest-compression ratios on improving cardiopulmonary resuscitation (CPR) quality and reducing fatigue during continuous chest compressions (CCC) in 10-min hands-only CPR scenario. MethodsThis prospective crossover study was conducted in 30 laypersons aged 18-65. Trained participants were randomized to follow different orders to perform following hands-only CPR methods: (1) CCC, 10-min CCC; (2) 4+6, 4-min CCC + 6-min of 10-s pause after 60-s compressions; (3) 2+8 (10/60), 2-min CCC + 8-min of 10-s pause after 60-s compressions; (4) 5/30, 2-min CCC + 8-min of 5-s pause after 30-s compressions; (5) 3/15, 2-min CCC + 8-min of 3-s pause after 15-s compressions. CPR quality (depth, rate, hands-off duration, chest compression fraction (CCF)) and participants’ fatigue indicators (heart rate, blood pressure, rating of perceived exertion (RPE)) were compared among methods of different rest-start points and different rest-compression ratios with CCC. ResultsTwenty-eight participants completed all methods. All resting methods reduced the trend of declining compression depth and the trend of increasing RPE while maintaining CCF of more than 86%. In methods with different rest-start points, the 2+8 method showed no difference in overall CPR quality or fatigue, but better CPR quality of every minute than 4+6 method. In methods with different rest-compression ratios, the 3/15 method showed the best CPR quality and the highest heart rate increment. ConclusionDuring prolonged hands-only CPR, appropriate transient rests were associated with higher CPR quality and lower subjectively perceived fatigue in laypersons.

Владимир Неговский: воплощение мечты

В статье очерчен жизненный путь и научно-исследовательская деятельность основателя реаниматологии (интенсивной терапии) В.А. Неговского (1909–2003). В 1936 г. он организовал первый в мире научный реанимационный центр, получивший название лаборатории специального назначения по проблеме «Восстановление жизненных процессов при явлениях, сходных со смертью». В период Великой Отечественной войны В.А. Неговским была организована фронтовая бригада, с которой он выехал на передовую и в 1943 г. впервые применил разработанный комплекс реанимационных мероприятий у раненых солдат. В защищенной в 1943 г. докторской диссертации «Восстановление жизненных функций организма, находящегося в состоянии агонии или периода клинической смерти» он изложил основные положения патофизиологии терминальных состояний и принципы комплексного метода оживления организма. В том же году диссертация была издана отдельной книгой. В 1945–1946 гг. В.А. Неговский опубликовал сообщения в журналах «JAMA» и «Nature» о клиническом опыте использования разработанного метода сердечно-легочной реанимации и важности разработки данной проблемы медицины, обеспечив, таким образом, приоритет в создании нового научного направления. Коллектив лаборатории в 1952 г. создал первую инструкцию «О внедрении в лечебную практику методов восстановления жизненных функций организма, находящегося в состоянии агонии или клинической смерти», которая была издана Министерством здравоохранения СССР для использования в клинической практике. Эта инструкция переиздавалась в 1955, 1959 и 1963 годах с внесением изменений в алгоритм сердечно-легочной реанимации. В 1959 г. по инициативе В.А. Неговского был организован первый в СССР прообраз реанимационного отделения, который получил название «Центр по лечению шока и терминальных состояний». В 1961 г. он сообщает о возникновении новой медицинской науки — реаниматологии, предметом изучения которой являются неспецифические общие патологические реакции организма, патогенез, терапия и профилактика терминальных состояний, жизнеобеспечение при критических состояниях. В 1972 г. в первом номере только что созданного журнала «Resuscitation» В.А. Неговский опубликовал статью «Второй шаг в реанимации — терапия постреанимационной болезни», в которой он изложил патофизиологические механизмы развития постреанимационных изменений в организме. Особой темой является преодоление «железного занавеса» и знакомство В.А. Неговского с американским создателем первых отделений интенсивного ухода П. Сафаром, которое заложило основу многолетнего научного взаимодействия и личной дружбы. В 1985 г. на основе лаборатории В.А. Неговским был организован Научно-исследовательский институт общей реаниматологии АМН СССР, который носит теперь его имя.

Modified Two-Rescuer CPR With a Two-Handed Mask-Face Seal Technique Is Superior To Conventional Two-Rescuer CPR With a One-Handed Mask-Face Seal Technique

Bag-valve-mask (BVM) ventilation using a two-handed mask-face seal has been shown to be superior to a one-handed mask-face seal during cardiopulmonary resuscitation (CPR). We aimed to compare CPR quality metrics during simulation-based two-rescuer CPR with a modified two-handed mask-face seal technique and two-rescuer CPR with the conventional one-handed mask-face seal technique. Participants performed two-rescuer CPR on a simulation manakin and alternated between the modified and conventional CPR methods. For the modified method, the first rescuer performed chest compressions and thereafter squeezed the BVM resuscitator bag during the ventilatory pause, while the second rescuer created a two-handed mask-face seal. For the conventional method, the first rescuer performed chest compressions and the second rescuer thereafter delivered rescue breaths by creating a mask-face seal with one hand and squeezing the BVM resuscitator bag with the other hand. Among the 40 participants that were enrolled, the mean ± standard deviation (SD) delivered respiratory volume was significantly higher for the modified two-rescuer method (319.4 ± 71.4 mL vs. 190.2 ± 50.5 mL; p < 0.0001). There were no statistically significant differences between the two methods with regard to mean ± SD compression rate (117.05 ± 9.67 compressions/min vs. 118.08 ± 10.99 compressions/min; p = 0.477), compression depth (52.80 ± 5.57 mm vs. 52.77 ± 6.77 mm; p = 0.980), chest compression fraction (75.92% ± 2.14% vs. 76.57% ± 2.57%; p = 0.186), and ventilatory pause time (4.62 ± 0.64 s vs. 4.56 ± 0.43 s; p = 0.288). With minor modifications to the conventional method of simulated two-rescuer CPR, rescuers can deliver significantly higher volumes of rescue breaths without compromising the quality of chest compressions.

Chest compression efficiency for three methods of single-person rescuer infant cardiopulmonary resuscitation

Chest compression efficiency for three methods of single-person rescuer infant cardiopulmonary resuscitation

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death.

Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method of cardiopulmonary resuscitation to improve outcomes from cardiac arrest. This approach targets patients with out-of-hospital cardiac arrest previously unresponsive and refractory to standard treatment, combining approximately 1 h of standard CPR followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and coronary artery revascularization. Despite its relatively new emergence for the treatment of cardiac arrest, the approach is grounded in a vast body of preclinical and clinical data that demonstrate significantly improved survival and neurological outcomes despite unprecedented, prolonged periods of CPR. In this review, we detail the principles behind VA-ECMO-facilitated resuscitation, contemporary clinical approaches with outcomes, and address the emerging new understanding of the process of death and capability for neurological recovery.

Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.

Basic life support training for the adult lay population. A systematic review

Cardiopulmonary resuscitation (CPR) training is an influential method for improving the perception of resuscitation maneuvers, user willingness to carry it out, and also coordination of the people performing it. The main objective of the present systematic review is to evaluate the effects of basic CPR training program and Semi-Automatic External Defibrillation (AED) use on acquiring and retaining practical skills of lay adults. The included researches involved adult participants of 18 years old and over without previous CPR official training. In addition, the studies containing any training program, without a specified training method of CPR and AED use, were considered. A qualitative analysis was conducted to determine the most efficient B-CPR and AED use training program for lay adults regarding to acquisition and retention of practical skills. All randomized experimental trials followed a sequence of assigning participants to different categories. This corresponds to distinct interventions which in turn involved various CPR and AED training types or different durations of training between the groups. Overall, a specific training methodology has not been identified for approaching a clear demonstration with more effective and low-cost results. However, it seems that a training program based on simplified and short-term CPR combined with instructor-student feedback, videos, feedback devices, and simulations could cause reduction of the barriers for the lay population to help the OHCA patients and perform CPR.