Cardiopulmonary Resuscitation Performance Research Articles

Impact of virtual problem-based learning of cardiopulmonary resuscitation on fourth-year nursing students’ satisfaction and performance: a quasi-experimental study

BackgroundRegarding competency of nursing students in cardiopulmonary resuscitation (CPR), nursing students frequently exhibit inadequate performance and low satisfaction levels regarding CPR training methods. The problem-based learning (PBL) method, characterized by a constructivist approach, has been underutilized for CPR training, particularly in a virtual format. Hence, this study aims to assess the influence of virtual problem-based learning in cardiopulmonary resuscitation on the satisfaction and performance of fourth-year nursing students.MethodsThis quasi-experimental study, conducted in 2022, involved 80 final-year nursing students from Hamadan University of Medical Sciences, Iran. The participants were randomly assigned to either the experimental group (N = 40) or the control group (N = 40). The experimental group was further divided into six smaller groups on WhatsApp. Both groups initially received routine training sessions, after which the experimental group engaged in four problem-based learning sessions across three different scenarios. Data collection included demographic information, a teaching satisfaction questionnaire, and cardiopulmonary resuscitation checklists administered immediately and one month after the intervention.ResultsThe study was initiated and concluded with 80 participants. The study commenced with no significant disparity in the mean scores of cardiopulmonary resuscitation performance, encompassing chest compressions (P = 0.451) and airway management (P = 0.378), as well as teaching satisfaction (p = 0.115) among the nursing students between the experimental and control groups. However, subsequent to the intervention, both immediately and one month later, the experimental group displayed notable enhancements in mean scores for cardiopulmonary resuscitation performance, comprising chest compressions (p < 0.001) and airway management (p < 0.001), as well as teaching satisfaction (p < 0.001) compared to the control group.ConclusionBased on the study’s findings, it is recommended that nursing educators implement this approach in their teaching practices.

The importance of the team in small animal CPR

This review draws on evidence from human medicine to assess the team factors most relevant to small animal cardiopulmonary resuscitation (CPR). It is increasingly being recognised that leadership, team building, communication and situational awareness all impact both the team's experience and clinical outcomes. Leadership training, nurse-led teams, debriefing, closed-loop communication and cognitive aids have all been shown to improve CPR performance and thus deserve consideration alongside the practical elements of arrest and resuscitation. There is limited primary evidence to support this claim in veterinary medicine. However, the mental models underpinning clinical human factors are largely seen as transferable, with veterinary governing bodies supporting their inclusion in practice culture and training.

Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service.

Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission. All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years. The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects. Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.

Incorporation of Drone Technology Into the Chain of Survival for OHCA: Estimation of Time Needed for Bystander Treatment of OHCA and CPR Performance.

Drone-delivered automated external defibrillators (AEDs) hold promises in the treatment of out-of-hospital cardiac arrest. Our objective was to estimate the time needed to perform resuscitation with a drone-delivered AED and to measure cardiopulmonary resuscitation (CPR) quality. Mock out-of-hospital cardiac arrest simulations that included a 9-1-1 call, CPR, and drone-delivered AED were conducted. Each simulation was timed and video-recorded. CPR performance metrics were recorded by a Laerdal Resusci Anne Quality Feedback System. Multivariable regression modeling examined factors associated with time from 9-1-1 call to AED shock and CPR quality metrics (compression rate, depth, recoil, and chest compression fraction). Comparisons were made among those with recent CPR training (≤2 years) versus no recent (>2 years) or prior CPR training. We recruited 51 research participants between September 2019 and March 2020. The median age was 34 (Q1-Q3, 23-54) years, 56.9% were female, and 41.2% had recent CPR training. The median time from 9-1-1 call to initiation of CPR was 1:19 (Q1-Q3, 1:06-1:26) minutes. A median time of 1:59 (Q1-Q3, 01:50-02:20) minutes was needed to retrieve a drone-delivered AED and deliver a shock. The median CPR compression rate was 115 (Q1-Q3, 109-124) beats per minute, the correct compression depth percentage was 92% (Q1-Q3, 25-98), and the chest compression fraction was 46.7% (Q1-Q3, 39.9%-50.6%). Recent CPR training was not associated with CPR quality or time from 9-1-1 call to AED shock. Younger age (per 10-year increase; β, 9.97 [95% CI, 4.63-15.31] s; P<0.001) and prior experience with AED (β, -30.0 [95% CI, -50.1 to -10.0] s; P=0.004) were associated with more rapid time from 9-1-1 call to AED shock. Prior AED use (β, 6.71 [95% CI, 1.62-11.79]; P=0.011) was associated with improved chest compression fraction percentage. Research participants were able to rapidly retrieve an AED from a drone while largely maintaining CPR quality according to American Heart Association guidelines. Chest compression fraction was lower than expected.

Student Pharmacist-Led Basic Life Support Training for High School Students Improves Knowledge and Skill Achievement.

Introduction: The performance of bystander cardiopulmonary resuscitation (CPR) improves survival among cardiac arrest victims. Near-peer teaching of Basic Life Support (BLS) may be an effective way to deliver resuscitation education. This article aims to assess the effectiveness of a student pharmacist-led American Heart Association (AHA) BLS course on high school students' knowledge and skill achievement. Methods: Student pharmacists were trained as AHA instructors and delivered BLS certification courses to high school students. Participants completed pre- and post-assessments adapted from the course learning objectives. Skills performance was evaluated using the AHA's standardized forms. Participants completed questions regarding their perceptions of the pharmacist's role in BLS and confidence in pursuing a career in healthcare. Results: There were 321 participants with the majority in 11th or 12th grade (86.6%) and attending public school (99.1%). After completing the training, the mean percentage of correct assessment responses increased from 41.2% to 89% (p <0.0001). All participants correctly performed BLS skills. Most participants strongly agreed or agreed that the course changed their perspective of the pharmacist's role during BLS (74.8%) and increased their confidence in their decision to pursue future careers in healthcare (61.7%). Conclusion: Student pharmacist-led BLS training, using near-peer delivery, improves high school students' knowledge and skill achievement. This strategy promotes high school students' positive perceptions regarding pharmacists and their role in BLS, as well as their confidence in pursuing careers in healthcare.

Cardiopulmonary Resuscitation Education in United States Schools: Shortcomings and Future Directions.

Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that is performed during a cardiac arrest. CPR consists of chest compressions, rescue breaths, and the usage of an automated external defibrillator (AED) based on availability. Performance of CPR can greatly increase the chances of survival by enabling the manual perfusion of vital organs in lieu of the heart's normal function. Despite extensive studies demonstrating the efficacy and necessity of CPR in an emergency, most of the public across the United States is ill-equipped and/or educated on how to perform it. While there may be other contributing factors, the lack of CPR education across schools in the United States almost certainly furthers the CPR illiteracy of the general population. Although states require some degree of CPR training, the level of education that students receive varies widely across communities and school districts, largely dictated by the available funding for training courses. Despite the lack of CPR education in the United States, studies conducted abroad have shown the efficacy of a CPR course in preparing students to respond in emergencies-lending hope to mending the current situation in the United States. In this article, we analyze legislation dictating CPR instruction and hypothesize ways in which states' Department of Education might be able to promote education and hands-on experience for students across all ages of schooling. Ultimately, we hope to highlight the importance and feasibility of preparing the next generation of citizens across the United States to respond when their name is called upon in an emergency.

Enhancing Cardiopulmonary Resuscitation Training with Mixed Reality: Improving Cardiopulmonary Resuscitation Performance and Enjoyment

Enhancing Cardiopulmonary Resuscitation Training with Mixed Reality: Improving Cardiopulmonary Resuscitation Performance and Enjoyment

Kalıpyargı Tehditinin Kardiopulmoner Resüsitasyon Performansı Üzerine Etkisi: Bir Randomize Kontrollü Manken Çalışması

Objective: Stereotype threat (ST) can lead to decreased performance when individuals face the possibility of confirming negative stereotypes associated with their group. During the Coronavirus disease 2019 (COVID-19) pandemic, non-Intensive Care Unit physicians (non-ICUp) were assigned to work in ICUs. However, social media emphasized the inadequacy of knowledge and skills among these physicians. Given the negative judgments, the study aimed to evaluate the cardiopulmonary resuscitation (CPR) performances of these physicians and investigate the effect of ST. Methods: A total of 63 non-ICUp and 53 Intensive Care Unit physicians (ICUp) physicians working in COVID-19 ICUs were randomly assigned to control and experimental groups. In the experimental group, ST was manipulated by presenting the study’s aim as measuring the difference in CPR performances between ICUp and non-ICUp physicians. The control group received no information. Participants were videotaped while performing a standard CPR scenario and evaluated by independent instructors and mannequin scores. Results: Overall CPR scores were higher among ICUp. Non-ICUp performed better in the ST condition regarding effective chest compression (p=.02) and correct compression rates per minute (p=.02) compared to the control condition. However, ICUp had lower scores for correctly placing chest compressions in the ST condition (p=.03). Conclusion: The higher CPR performance among ICUp was expected. However, the hypothesis suggesting lower performance for non-ICUp under ST conditions was not supported. Inconsistent results regarding the ST effect could be influenced by moderating factors such as task difficulty, knowledge about the existing stereotype, and motivation to perform well. The interaction between the physicians’ specialty and situational factors highlights the importance of creating realistic training environments that simulate high-pressure situations, ultimately contributing to the development of competent and confident healthcare professionals. Future research should further explore the impact of ST-based training on interactions and performance among different healthcare professionals. Keywords: Stereotype threat, intensive care unit, cardiopulmonary resuscitation, CovId-19

Analysis of Out-of-Hospital First Aid for Recovery of Spontaneous Circulation after Cardiac Arrest in Korea.

The characteristics of an individual patient experiencing out-of-hospital cardiac arrest who recovered spontaneous circulation with the assistance of witnesses and paramedics were examined. The analysis of bystander cardiopulmonary resuscitation (CPR) and the professional first aid efforts of paramedics in the pre-hospital environment is pivotal to enhancing the survival rate of out-of-hospital cardiac arrest patients. The data used in this study were extracted from the Korea Centers for Disease Control and Prevention (KCDC) nationally recognized statistics, Acute Heart Failure big data survey. Out-of-hospital cardiac arrest (OHCA) customer data were collected from the Gangwon Fire Headquarters public information database as social management data. The data were analyzed using SPSS 24. The study's results emphasized the significance of offering basic CPR training to the public. This is evident from the fact that 90.5% of the first witnesses in the study performed CPR on OHCA patients, resulting in the recovery of spontaneous circulation (ROSC). The majority of patients with ROSC were male, with the highest age group being 41-50 years. Heart disease, hypertension, and diabetes were common medical conditions. The rate of witnessing cardiac arrest was high. Among the first witnesses, about 78.4% were of cardiac arrest incidents involving family members, co-workers, or acquaintances; 12.2% were on-duty medical healthcare personnel; and 9.5% were off-duty healthcare personnel. Cardiac arrest was treated in 83.8% of cases, with 90% of witnesses performing CPR. The percentage of witnesses that used an automated external defibrillator (AED) was 13.5%. In this study, the rates of ECG monitoring, CPR performance, and defibrillation performed by paramedics were high, but intravascular access and drug administration had a lower rate of performance. The time elapsed depended on the patient's physical fitness. The study found that paramedics had the highest CPC restoration rate in patients with cardiac arrest, followed by EMTs and nurses. Significant differences were observed in cerebral performance scores after care by these paramedics and nurses. To increase the performance of AEDs, more AEDs should be installed in public spaces so that the public can access them conveniently in cases of emergency. In addition, it is necessary to improve the quality of professional first aid physical activity services performed by first-class paramedics.

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

Barriers to CPR initiation and continuation during the emergency call relating to out-of-hospital cardiac arrest: A descriptive cohort study

AimTo describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA). MethodsWe analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January – 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient. Calls were listened to in full and coded in terms of barriers to CPR initiation and continuation, and patient and caller characteristics. ResultsOverall, CPR was performed in 69% of calls and, in 85% of these, callers continued performing CPR until EMS arrival. Nearly all callers (99%) experienced barriers to CPR initiation and/or continuation during the call. The barriers identified were classified into eight categories: reluctance, appropriateness, emotion, bystander physical ability, patient access, leaving the scene, communication failure, caller actions and call-taker instructions. Of these, bystander physical ability was the most prevalent barrier to both CPR initiation and continuation, occurring in 191 (65%) calls, followed by communication failure which occurred in 160 (54%) calls. Callers stopping or interrupting CPR performance due to being fatigued was lower than expected (n = 54, 26% of callers who performed CPR). Barriers to CPR initiation that related to bystander physical ability, caller actions, communication failure, emotion, leaving the scene, patient access, procedural barriers, and reluctance were mostly overcome by the caller (i.e., CPR was performed). ConclusionBarriers to CPR initiation and continuation were commonly experienced by callers, however they were frequently overcome. Future research should investigate the strategies that were successful.

비보건계열 대학생 대상 시뮬레이션 기반 심폐소생술 교육 프로그램의 효과

Objectives The purpose of this study is to develop simulation-based cardiopulmonary resuscitation education and apply it to non-health related college students to understand its effect.&#x0D; Methods This study was conducted on 54 non-health college students (27 in the experimental group and 27 in the control group). The control group received the general cardiopulmonary resuscitation (CPR) education, and the experimental group received the shortened version of the CPR education provided to the control group and the simulation-based CPR education developed in this study.&#x0D; Results Simulation-based CPR education was developed and applied in five stages: analysis, design, development, implement, and evaluation. The experimental group's cardiopulmonary resuscitation performance was 41.22±3.91 points, and the control group's cardiopulmonary resuscitation performance was 28.15±4.05 points, indicating a significant difference in cardiopulmonary resuscitation performance (Z=-6.32, p=&lt;.001). There were no significant differences in knowledge of CPR (Z=-0.04, p=.972), confidence in performing CPR (Z=1.00, p=.922), education satisfaction (Z=-0.28, p=.782), and immersion (Z=-0.08, p=.935).&#x0D; Conclusions Simulation-based CPR education programs was found to be effective in improving CPR performance. Therefore, the simulation-based CPR program can be used as an effective educational method for non-health college students, and it is necessary to consider ways that can be applied not only to college students but also to the general public.

Abstract 383: Effect of Audiovisual Feedback Device Type on Prehospital Chest Compression Quality During Prehospital Resuscitation

Background: Real-time audiovisual feedback devices have been implemented to optimize cardiopulmonary resuscitation (CPR) performance during out-of-hospital cardiac arrest (OHCA). Emergency medical service (EMS) personnel perceive different levels of usability regarding feedback device type. The study aimed to evaluate the effect of type of audiovisual feedback device used during prehospital CPR on chest compression quality during prehospital resuscitation. Method: Adult OHCA patients who received CPR by EMS personnel utilizing feedback device in Seoul between April 2020 and December 2021 were included. Cases that utilized mechanical chest compression devices were excluded. Feedback devices were classified into two types: sticker-type (S-type) and puck-type (P-type). The quality of chest compressions during prehospital resuscitation was compared based on the feedback device type. The primary outcome assessed was chest compression depth. Subgroup analysis was conducted for cases in which EMS personnel had experience using both types of devices. Results: In total, 2,896 OHCA cases were included. 1,596 cases utilized S-type devices and 1,300 cases utilized P-type devices. The median chest compression depth was significantly higher in cases that utilized the S-type device (Median: 5.2, interquartile range (IQR): 4.5-5.8) compared to those that used the P-type device (Median: 4.3, IQR: 3.7-5.0) (P&lt;0.001). In addition, proportion of chest compressions with adequate depth (5-6 cm) was significantly higher in the S-type group, while average chest compression rate and chest compression fraction were higher in the P-type group. Similar findings were observed in the subgroup analysis. Conclusion: Difference in chest compression quality parameters were observed during prehospital resuscitation according to type of audiovisual feedback device utilized. Chest compression quality regarding chest compression depth was superior when S-type feedback device was used.

Abstract 308: Comparison of Cardiopulmonary Resuscitation Performance Between Integrated CPR Device Performing Chest Compression and External Defibrillation versus LUCAS3 With Automated External Defibrillator: A Animal and Manikin-Based Pilot Study

Background: Early chest compression and defibrillation are important components for successful resuscitation. The use of mechanical CPR has increased after the outbreak of COVID-19, and this trend continued in the post-pandemic period. We developed an automatic CPR performing chest compression and external defibrillation simultaneously following current CPR algorithm. Methods: This study was designed as a study to compare the performance of CPR and AED between automatic CPR apparatus (A-CPR) and commercially proven mechanical CPR device (LUCAS3) plus AED (C-CPR) during CPR in swine cardiac arrest model and the study to evaluate feasibility of A-CPR in simulated cardiac arrest model. Results: There were no significant differences in hemodynamic variables between the groups. Time to ECG analysis [38.0 sec in A-CPR, 48.0 sec in C-CPR, p =0.010], time to initial shock advice plus subsequent chest compression [46.0 sec in A-CPR, 57.0 sec in C-CPR, p =0.017], time to first defibrillation [48.5 sec in A-CPR, 65.0 sec in C-CPR, p =0.004], charge to shock interval [3.0 sec in A-CPR, 8.0 sec in C-CPR, p =0.001], and hands-off time [11.0 sec in A-CPR, 22.5 sec in C-CPR, p =0.001] were significantly shorter in A-CPR group than C-CPR group. In the simulation study, the pure chest compression time [101 sec in A-CPR, 110 sec in C-CPR, p&lt; 0.001], hands-off time [75 sec in A-CPR, 94 sec in C-CPR, p&lt; 0.001], time from power-on to first chest compression [55 sec in A-CPR, 82 sec in C-CPR, p&lt; 0.001], time to first shock delivery [40 sec in A-CPR, 51 sec in C-CPR, p= 0.001] were significantly shorter in A-CPR group than C-CPR group, respectively. Chest compression fraction showed a significant higher in A-CPR than C-CPR [57% in A-CPR, 54% in C-CPR, p &lt;0.001]. Conclusions: The A-CPR device demonstrated significant time savings effect than conventional mechanical CPR device and automated external defibrillation device. In addition, A-CPR and C-CPR showed similar hemodynamic effects and resuscitation outcomes in a swine model of cardiac arrest

Cardiopulmonary Resuscitation-Related Head Trauma: A Case Report

Introduction: In all cases of cardiac arrest, adequate cardiopulmonary resuscitation (CPR) performance is crucial for survival. There are differences between the performances of CPR in pediatric cases compared to CPR in adults. In all cases in which CPR is needed, there is a possibility for the occurrence of CPR-related traumatic injuries. Aims and methods: We used all available forensic examination methods in order to provide objective forensic investigation conclusions and feedback to clinicians. Results: We present an untypical case of head trauma with intracranial bleeding caused via CPR-related traumatic injury. Although it is not connected with the mechanism and genesis of death, it should be noted as being practically casuistic. The child had a severe congenital heart malformation. The surgical team decided that surgery was absolutely necessary. Complications developed in the postoperative period. On the second postoperative day, cardiac arrest occurred, CPR was performed, and the girl survived for 15 minuntil there was a second cardiac arrest. A second CPR was performed, but she died. During the forensic autopsy, with the exception of expected findings, head bruising and intracranial bleeding were registered. Conclusion: The forensic conclusion was that the head trauma was caused accidentally during CPR due to the non-voluntary impact of the head with respect to the background of anticoagulant therapy, which was one possible factor for the massive bleeding.

Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia.

Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.

Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest.

Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (P=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (P<0.001). Median chest compression rate per minute was 111 and 109 (P<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (P<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (P<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (P<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.

Resuscitation Quality Improvement: Improving Clinicians' Performance.

Although cardiopulmonary resuscitation (CPR) renewal occurs every 2 years, quality of performed CPR at the study site was below American Heart Association (AHA) standards. Resuscitation Quality Improvement (RQI) is a new AHA program with the premise that practicing CPR more frequently using audiovisual feedback can improve performance. To identify whether performance of chest compressions during training reassessments improves with RQI. This study used a preintervention-postintervention design. Critical care nurses from 2 intensive care units performed a baseline round of chest compressions. These baseline data reflected CPR performance with traditional training. The next week, participants completed RQI training. Two weeks after RQI training, participants performed chest compressions. Five weeks after RQI training, participants performed a third round of chest compressions. The compressions performed 2 and 5 weeks after RQI used audiovisual feedback. Thirty nurses participated. Before intervention, the mean (SD) for overall compression compliance was 32.68% (26.96%), depth was 67.76% (30.15%), and rate was 39.95% (27.41%). The first postintervention (RQI plus 2 weeks) mean (SD) increased to 75.33% (33.70%) for overall compression compliance, 97.43% (12.04%) for depth, and 80.89% (29.35%) for rate. The second postintervention (RQI plus 5 weeks) mean (SD) decreased slightly to 73.16% (36.36%) for overall compression compliance, 96.57% (13.04%) for depth, and 78.75% (31.83%) for rate. Frequent CPR using RQI technology, with its immediate audiovisual feedback, helps maintain skills, which may improve patient outcomes.

One hand open palm technique for infant CPR

BackgroundThe guideline recommended chest compression depth, rate, and recoil are essential factors for the return of spontaneous circulation (ROSC) in cardiopulmonary resuscitation (CPR). A pediatric resuscitation collaboration recently demonstrated that healthcare providers fail to meet the American Heart Association (AHA) guidelines, with the greatest difficulty being in achieving chest compression depth targets in infants. We hypothesized that the use of the heel of one hand [open palm technique (OPT)] will increase chest compression depth in infants compared to standard CPR techniques [two-finger technique (TFT), two thumb-encircling hand technique (TTT)].MethodsA prospective, randomized, single-center study was completed using an infant manikin. Thirty pediatric critical care providers performed 2 min of CPR for each technique followed by 5 min of rest. Each participant completed a survey at the end that assessed the difficulty level in order to assess the feasibility of this new technique.ResultsThe mean chest compression depth for the OPT was significantly deeper compared to TFT (2.61± 0.63 cm vs. 2.25 ± 0.54 cm, p = 0.0004) but not significantly deeper compared to TTT (2.43 ± 0.46 cm, p = 0.0820). OPT was graded as the easiest technique, followed by TTT (2.20 ± 0.76 vs. 3.17 ± 0.95, p &amp;lt; 0.0001) and then TFT (3.38 ± 0.83, p &amp;lt; 0.0001).ConclusionThe use of OPT for infant CPR resulted in improved chest compression depth. OPT was considered the easiest technique compared to standard infant CPR techniques, thus making it feasible to perform. Importantly, all providers failed to meet the AHA infant chest compression depth goal of 4 cm, regardless of the technique. Future research is needed to optimize CPR technique and performance to achieve targeted chest compression depth in infants.

Association of CPR simulation program characteristics with simulated and actual performance during paediatric in-hospital cardiac arrest

AimTo evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest. MethodsThis is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016–March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded. Actual CPR performance was recorded for children 37 weeks post-conceptual age to 18 years who received chest compressions of any duration, and included intra-arrest haemodynamics and CPR mechanics. Outcomes included survival to hospital discharge with favourable neurologic status. ResultsOverall, 18,912 point-of-care simulations were included. Simulation characteristics associated with both simulation and actual performance included site, participant discipline, and timing of simulation training. Simulation characteristics were not associated with survival with favourable neurologic outcome. However, participants in the top 3 sites for improvement in survival with favourable neurologic outcome were more likely to have participated in a simulation in the past month, on a weekday day, to be nurses, and to achieve targeted depth of compression and chest compression fraction goals during simulations than the bottom 3 sites. ConclusionsPoint-of-care simulation characteristics were associated with both simulated and actual CPR performance. More recent simulation, increased nursing participation, and simulation training during daytime hours may improve CPR performance.