Cardiopulmonary Resuscitation Process Research Articles

Designing of a High-Quality CPR Simulation Game Clinical Scenario for Nursing Students: A Qualitative Study

Cardiopulmonary resuscitation (CPR) is an important skill for nursing students. The process of learning high-quality CPR with a simulation-based learning method can be developed into a simulation game. In order to develop a CPR HQ simulation game, a clinical scenario that can be used as a guide in carrying out storyboards is needed. This research aims to formulate a simulation scenario that will serve as the basis for developing a high-quality CPR simulation game to increase nursing students' competency. This qualitative research uses a Participatory Action Research (PAR) approach by inviting 15 respondents from the prospective user population, namely Emergency Nursing Lecturers, Emergency Room Nurses, BLS Trainers, and nursing students, to carry out Focus Group Discussions. The study's results revealed clinical scenarios that were arranged based on 4 themes, including 1) suitability of the competency being tested, 2) minimum competency for 5 cycles of CPR, 3) settings in the pre-and intrahospital scope, and 4) choice of patient outcome. These components are crucial when designing simulation scenarios that support students’ cognitive processes to achieve High-Quality CPR in nursing students. Thus, the results of this research can then be used as a guide in developing the HQ-CPR game as a learning medium for nursing students.

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situations and requires strict implementation of cardiopulmonary resuscitation (CPR) protocols. Since ultrasound is one of the recommended tools to determine the presence of cardiac movements and may be a predictor of the outcome, this study examined the relationship between echocardiographic findings during CPR with patients’ outcomes. Methods: This cross-sectional prospective observational study was conducted on patients with cardio-respiratory arrest in the emergency department of Shariaty hospital during 2019. sampling method was random. Echocardiography was done at the patient’s bedside during the CPR process in accordance with the last advanced cardiac life support (ACLS) guidelines, on two points, after the end of the second and 10th minutes from the start of CPR. The echocardiography findings (cardiac movement vs standstill) were recorded, and patient outcomes were followed. Thirty-two patients enrolled in this study with a mean age of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate the association between heart contractions during resuscitation and the outcomes via SPSS V.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationship between heart rhythm in the second and tenth minutes with the outcomes of CPR. Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to the findings of the second minute, had a significant correlation with the success rate of CPR and outcomes (P<0.05). Moreover, patients with ventricular tachycardia (VT)/ventricular fibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, and better outcome than patients with other cardiac rhythms and asystole (P<0.05). Conclusion: Echocardiographic findings in the 10th minute of the CPR process can be used as a prognostic factor for cardiac arrest.

Interactive Teaching Aid Kit for Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on a person experiencing cardiac arrest to manually preserve brain function until spontaneous breathing and blood circulation can be restored. If performed timely and properly, it can improve the survival rate of a person experiencing cardiac arrest. The promotion of CPR has always been an important task for countries around the world. Countries around the world often hold relevant study camps and seminars to improve the public’s awareness of CPR. On the basis of this rationale, this paper proposes an interactive teaching aid kit for CPR that uses a CPR manikin and tutoring software to facilitate CPR learning among trainees. The CPR manikin is equipped with sensors that determine whether the CPR steps are performed correctly. Data from the sensors are sent to the tutoring software through wireless transmission. The software provides video demonstrations and textual instructions concerning the standard CPR procedure. In this software, the interactive interface displays real-time information about the trainee’s CPR process, such as information on the CPR step being performed and the number of chest compression and breaths given. Thus, this teaching aid kit allows trainees to learn CPR without an instructor. This system may enable CPR to become a readily learnable skill for the general population.

Investigating the effects of external pressure on coronary arteries with plaques and its role in coronary artery disease

The risk of an acute coronary event stems from the amount and type of plaque present, as well as the fluid and structural dynamics in the coronary artery. If the plaque’s structural stress exceeds the mechanical strength, the fibrous cap may rupture and lead to thrombosis. The patient is then likely to face a sudden myocardial infarction. An association between Coronary Heart Disease (CHD) and Sudden Cardiac Death (SCD) has been long recognised. For the first time, we are reporting a correlation between applied external pressure, such as Cardiopulmonary Resuscitation (CPR), coughing, sneezing, blowing one’s nose, etc., and diseased coronary artery plaque via 3 D coronary artery models and two-way Fluid-Solid Interaction (FSI) models. Shear and von Mises stresses inside arteries and plaques have been shown to play a major role in plaque development, progression of disease, and the likelihood of plaque rupture. Our results show a drastic change in maximum shear (300%) and von Mises stresses (500%) with increasing external pressure. This change may indicate an onset of imminent plaque rupture. Furthermore, FSI modelling indicates a strong correlation between plaque thickness, location, and external pressure. With further clinical and simulation studies, this information could be helpful in understanding potential limit pressure in the CPR process for patients with CHD.

Critical care nurses' moral sensitivity during cardiopulmonary resuscitation: Qualitative perspectives.

Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients' unconsciousness. In such circumstances, nurses' ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. Four themes and 12 sub-themes were extracted from the analysis of the data, including "Consciously and compassionate attention to resuscitate the patient," "Awareness of families' anxiety," "Understanding the teamwork and interactive guidance of the CPR process," and "Compulsory violation of moral principles." It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions.

Human Reliability Analysis for Cardiopulmonary Resuscitation Process in Emergency Medicine Using a Modified Hybrid Method Based on the Markov Model and Fault Tree Analysis

Introduction:In emergency departments (ED), human reliability assessment is essential for improving the quality of treatment and preventing medical accidents. A medical accident is expressed as an injury to a patient caused by the negligence of a doctor or nurse who is providing medical care. This study aimed to assess the human reliability in the cardiopulmonary resuscitation (CPR) process and recommend some comments to minimize human errors and improve patient safety.Materials and Methods: The main factors in the CPR process (such as rate and depth of chest compression and rate of ventilation) are identified based on the American heart association (AHA) roles. Data were recorded during three months in the evening shifts in the ED and CPR room of Imam Reza Hospital in Mashhad, Iran. In total, 42 samples were collected, and a modified hybrid approach according to the fault tree analysis and Markov method was proposed for the analysis of CPR team (including emergency medicine, medical interns, and nurses) reliability in the resuscitation process. Finally, the important basic events (errors) were selected using the Boruta algorithm by R software.Results: An FTA-Markov-based hybrid method is considered to compute the human reliability in the CPR process. The obtained results from human reliability analysis using the sensitivity analysis via Boruta algorithm and the proposed hybrid method show that an interrupt between chest compression process for rhythm control, the cycle of CPR, the depth of chest compression, and the discussion about reversible causes are the most effective factors in the human reliability of CPR process.Conclusion:The human reliability of the CPR process in the ED has been assessed using a hybrid method based on the FTA and Markov method for the first time. To improve the quality of treatment and prevent medical accidents during the CPR process, the main factors in the process are identified, and then, the proposed hybrid method is used to calculate human reliability.

Application of Cardiopulmonary Resuscitation Mechanism in Infant Population: A Short Review

Cardiac arrest (CA) is a significant issue in infants worldwide, which causes disagreeable morbidity and mortality ratios. Thus, cardiopulmonary resuscitation (CPR) is a technique performed in case of cardiac arrest to save victims’ lives. The aim of CPR is to follow the blood flow promoting to the vital organs during the external chest provisional compressions. This technique has been reported to develop CA results. It was reported that CPR was not performed in high quality even when highly qualified rescuers delivered by CPR. Therefore, international guidelines have proposed for applying a CPR feedback device to release high-quality CPR to enhance survival rates. There is currently no feedback device available to guide learners through infant CPR performance compared to the adequate number of the adult in CPR feedback device. This study establishes a background knowledge to understand the CPR technique in infant populations by reviewing the following: the critical role of chest compression and rescue breath during the CPR process, the CPR standards, increasing the cardiac arrest survival rate by performing high-quality CPR, the effect of feedback on CPR performance., outlining the effect of different compression techniques on all the hemodynamic outcomes for delivering high-quality infant CPR.

Analysis on clinical characteristics of patients undergoing CPR in department of emergency and factors influencing the success of resuscitation

To analyze the clinical data and characteristics of patients undergoing cardiopulmonary resuscitation (CPR) in the emergency department and the factors affecting the success of resuscitation, so as to allocate medical resources in emergency department, improve the CPR process and increase the success rate of CPR. 538 patients with cardiac arrest who were registered by Utstein in the emergency department of the Third Central Hospital of Tianjin from December 2009 to December 2019 were selected as study subjects. The clinical data and characteristics were analyzed. According to whether the resuscitation was successful, the patients were divided into successful group and failed group, and the factors influencing success of resuscitation were analyzed. A total of 538 patients were enrolled in this study, with an average age of (65.53±15.56) years old. The number of patients aged 71-80 years old was the largest (145 cases, 27.0%), followed by those aged 61-70 years old (105 cases, 19.5%) and 51-60 years old (99 cases, 18.4%). The main causes of cardiac arrest were acute myocardial infarction in 203 cases (37.7%), unknown causes in 77 cases (14.3%) and other cardiac causes in 61 cases (11.3%). The initial types of heart rhythm were no pulse electrical activity (215 cases, 40.0%) and cardiac arrest (179 cases, 33.3%). In this study, 195 patients were resuscitated successfully, and the success rate of recovery was 36.2%. Compared with the successful group, the time of onset to resuscitation (minutes: 14.94±1.03 vs. 9.02±1.05), start time of epinephrine application (minutes: 8.50±0.02 vs. 4.21±0.16), time of onset to endotracheal intubation success (minutes: 9.56±1.87 vs. 5.86±0.84) and total duration of CPR (minutes: 48.75±1.73 vs. 35.39±2.51) in the failed group were significantly prolonged (all P < 0.05), and the cumulative epinephrine dosage was significantly increased (mg: 8.48±4.81 vs. 6.31±4.86, P < 0.05). There were significant differences in the location of onset and main causes of cardiac arrest between the two groups (both P < 0.05), but there were no significant differences in gender, age, initial heart rate type and the proportion of defibrillation (all P > 0.05). Binary Logistic analysis showed that the time from onset to resuscitation [odds ratio (OR) = 1.763, 95% confidence interval (95%CI) was 1.713-1.804, P = 0.000], cumulative dosage of epinephrine (OR = 1.759, 95%CI was 1.708-1.765, P = 0.000), time of onset to endotracheal intubation success (OR = 1.023, 95%CI was 0.988-1.047, P = 0.008) and start time of epinephrine use (OR = 1.819, 95%CI was 1.785-1.946, P = 0.002) were risk factors for successful resuscitation (all P < 0.05). Cardiogenic disease is the main cause of cardiac arrest, and the time from onset to resuscitation, cumulative dosage of epinephrine, success time of endotracheal intubation and time of epinephrine application are independent factors influencing the success of resuscitation in department of emergency.

Do Rescuers' Physiological Responses and Anxiety Influence Quality Resuscitation under Extreme Temperatures?

Teaching and training cardiopulmonary resuscitation (CPR) through simulation is a priority in Health Sciences degrees. Although CPR is taught as a simulation, it can still be stressful for the trainees since it resembles a real-life circumstance. The aim of this study was to assess the physiological effects and anxiety levels of health sciences undergraduates when faced with CPR process in different temperatures (room temperature, extremely cold, or extremely warm). This was a descriptive cross-sectional before–after study conducted during the 2018/2019 academic year with 59 students registered in the Faculty of Health Sciences of the Castilla-La Mancha University (UCLM). State Trait Anxiety Inventory (STAI) questionnaires were distributed among the students before and after the CPR simulation. We found greater level of situational anxiety in undergraduates faced with extreme adverse temperature scenarios (extreme heat and cold), especially in conditions of extreme heat compared to controlled environment (at room temperature). We discovered differences regarding sex, in which men scored 6.4 ± 5.55 points (STAI after CPR score) and women scored 10.4 ± 7.89 points (STAI after CPR score). Furthermore, there was less lactate in blood, before and during the event in individuals with anxiety. In addition, beginning in Minute 7, we observed a remarkable decrease (but not significant) in the performance of rescuers with anxiety. Programs targeted at promoting coping mechanisms to reduce anxiety before a critical clinic situation should be implemented in academic training.

Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association.

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.

Study Monitoring in Emergency Care Trials: Lessons from the Resuscitation Outcomes Consortium Continuous Chest Compressions Trial.

Clinical trial investigators often assemble internal study monitoring committees (SMCs) to measure individual or group adherence with trial performance benchmarks. We examined the processes and results of study monitoring in an international trial of out-of-hospital cardiac arrest. We studied SMC operations for the Resuscitation Outcomes Consortium (ROC) Continuous Chest Compressions (CCC) trial, which compared continuous with interrupted chest compressions upon survival after out-of-hospital cardiac arrest. The SMC defined trial performance benchmarks, which included compliance with the intervention, cardiopulmonary resuscitation (CPR) process data availability and timely data completion. Trial investigators received monthly performance reports. We determined rates of trial noncompliance and suspension from the trial. ROC-CCC enrolled a total of 23,711 subjects in the primary analysis population. Across 113 enrolling agencies, the SMC monitored performance for a total 2,367 agency-months. Emergency medical services agencies were on probation for a total of 178 (7.5%) agency-months. Fifty-five agencies were placed on probation at least once, of which 78% improved their performance and were approved for continued participation in the trial. A total of 12 agencies were suspended from trial participation. Data monitoring resulted in high-quality CPR (mean chest compression fraction=0.80), 87% CPR process availability and timely data completion (75th and 95th percentiles prehospital data = 22 and 57 days; hospital data= 58 and 118 days). Study monitoring procedures may play an important role in ensuring the performance quality in acute care clinical trials.

Hands-on defibrillation with a safety barrier: An analysis of potential risk to rescuers

BackgroundInterruptions in compressions reducethe efficacy of cardiopulmonary resuscitation (CPR) and are inevitable during hands-off periods for shocks. Clinical exam gloves were found to facilitate safe contact with patients during shock delivery but the safety of this practice has been questioned. Polyethylene is of interest because of its safety record in the medical arena and its electrical insulation properties. MethodsThis study measured the current leak through 2 mil (0.002 inch) polyethylene drapes during shock delivery. The current leak was assessed by measurement of voltage changes in a circuit recommended by the International Electrotechnical Commission (IEC) for current leak safety testing. Current flowed off the drape, through the circuit and to electric ground in a manner consistent with standardized testing. Perceptibility was assessed in a subset with the investigator’s bare hands pressed into the drape during shock delivery. ResultsThirty-three patients undergoing elective cardioversion at Emory University Hospital underwent analysis (age 23–90, 36% female). Biphasic energies were 200–360 J. The root mean square (RMS) current leak averaged 0.072 ± 0.022 mA and peak current leak averaged 0.67 ± 0.21 which is well below IEC recommendations of 3.5 mA RMS and 5.0 mA peak. Finally, no instances of dielectric breakdown occurred and no shocks were perceptible. ConclusionsPolyethylene is a common medical material which may facilitate safe hands-on defibrillation. Our data illustrates that a thin, semitransparent layer of polyethylene is a safe and feasible adjunct to cardiac arrest kits to allow continued compressions and simplification of the CPR process.

Abstract 206: Cardiopulmonary Resuscitation Process Measures Associated With Return of Spontaneous Circulation in Non-Shockable Out-of-Hospital Cardiac Arrest

Purpose: Survival rates after non-shockable out-of-hospital cardiac arrest (OHCA) remain low despite advances in resuscitation. Cardiopulmonary resuscitation (CPR) process measures may inform treatment strategies. We hypothesized that CPR process measures would be associated with return of spontaneous circulation (ROSC) and patient electrocardiogram (ECG) transitions. Methods: We obtained defibrillator monitor data for emergency medical service (EMS)-treated non-shockable OHCA from the Resuscitation Outcomes Consortium (ROC), an OHCA research network (U.S./Canada). We extracted ECG data from EMS defibrillator files and parsed cases into compression-free analyzable segments using custom MATLAB software. Two data abstractors classified segment rhythms as PEA, asystole, ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), or ROSC. We calculated CPR process measures (average rate, depth, duration, leaning proportion, chest compression fraction, and duty cycle) for CPR bouts preceding every ECG segment. We used mixed effects models controlling for subject to test associations between individual CPR process measures and the bout-level outcomes ROSC and shockable rhythm. Results: We analyzed 1893 cases consisting of 7981 CPR bouts. Case initial rhythms were asystole (68.2%), PEA (24.9%), or NSA-AED (6.9%). Segment rhythm classifications were asystole (78.1%), PEA (20.4%), ROSC (5.5%), VF (1.4%), and PVT (0.07%). Regression model results are shown in Table 1. Chest compression fraction was most strongly associated with ROSC and shockable rhythm. Depth was also associated with shockable rhythm. Leaning proportion and duty cycle were not associated with either outcome. Conclusions: In cases of non-shockable OHCA, CPR quality measures were associated with ROSC and transition to a shockable rhythm at the bout level.

Pediatric Pharmacists' Participation in Cardiopulmonary Resuscitation Events.

The Pediatric Pharmacy Advocacy Group (PPAG) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation events. Acknowledging these obstacles, the PPAG encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) as evidenced by the impact pharmacist participation has shown on the reduction of hospital medication error and mortality rates in children. The PPAG advocates that pharmacists be actively involved in the institution's CPR, medical emergency team committees, and preparation of emergency drug kits and resuscitation trays. The PPAG advocates that all institutions requiring a pharmacist's participation in CPR events consider adoption of preparatory training programs. Although the PPAG does not advocate any one specific program, consideration should be taken to ensure that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including but not limited to basic life support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support algorithms; medication preparation and administration guidelines; medication compatibility; recommended dosing for emergency medications; and familiarity with the institutional emergency cart.

Evaluation of attitude of doctors and nurses of emergency department toward presence of patients’ relatives during cardiopulmonary resuscitation in selected emergency department centers in Urmia, Iran

Introduction: There are different aspects of the presence of family members in cardiopulmonary resuscitation (CPR). The present study was carried out with the aim to determine the attitude of nurses and physicians towards the presence of family members during CPR in educational hospitals of Urmia University of Medical Sciences, Urmia, Iran. Methods: In this study, 190 nurses and emergency medical staff were asked to complete a questionnaire. The sampling method was as counting all the participants. Data collection tool was a pre-designed questionnaire. The questionnaire consisted of two parts: the first and the second parts were respectively related to demographic information and family presence during resuscitation (FPDR) issue and various factors influencing this attitude. After collecting the data, their analysis was performed using SPSS software. Results: In this study, 62 (44.0%) and 101 (53.2%) of the participants respectively agreed and disagreed that during the CPR process, the relatives of the patients had the right to attend the resuscitation room. A significant number of participants in the study (64.2%) believed that the presence of the patient relatives during resuscitation violates the privacy of the patient, regardless of his/her prior consent. Conclusion: The findings of the study showed that many physicians and nurses opposed the presence of family members during the resuscitation process, and the number of individuals who agreed on this idea was much lower, however in some studies, physicians and nurses were agreed about the conditions. This can be due to cultural differences and conditions and also the place where resuscitation was performed.

Quality of Cardiopulmonary Resuscitation in Emergency Department Based on the AHA 2015 Guidelines; a Brief Report.

Adhering to existing guidelines on cardiopulmonary resuscitation (CPR) can increase the survival rate of the patients. The present study has been designed with the aim of determining the quality of CPR performed in the emergency department based on the latest protocol by the American heart association (AHA). In this prospective cross-sectional study CPR process was audited in patients above 18 years old in need of CPR presenting to the emergency departments of 3 teaching hospitals based on the AHA 2015 guidelines. Less than 60% agreement was considered as fail, 60-70% as poor, 70-80% as moderate, 80-90% as good, and 90-100% as excellent. 80 cases of CPR were audited (55% male). Location of arrest was the hospital in 58 (72.5%) cases and 48 (60.0%) of the cases happened during the day. 28 (35.0%) cases had orotracheal intubation before the initiation of CPR. 30 (37.5%) patients had a shockable rhythm at the initiation of CPR. Based on the findings, out of the 31 studied items, 9 (29.03%) had excellent agreement, 10 (32.25%) had good, 4 (12.90%) had moderate, 2 (6.45%) had poor, and 6 (19.35%) had fail agreement rate. Based on the findings of the present study, the quality of applying the principles of basic and advanced CPR in the emergency department of the studied hospital had intermediate, poor and fail agreement with the recommendations of the AHA 2015 in at least one third of the cases.

Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study

IntroductionThe study aimed to determine the effect of community implementation of a bundles of cardiopulmonary resuscitation (CPR) programs on outcomes in out-of-hospital cardiac arrest (OHCA). MethodsA before- and after-intervention study was performed in a metropolis. Emergency medical services (EMS)-treated adults and cardiac OHCAs were included. Three new CPR programs was implemented in January 2015: 1) a high-quality dispatcher-assisted CPR program (DACPR), 2) a multi-tier response (MTR) program using fire engines or basic life support vehicles, and 3) a feedback CPR (FCPR) program with professional recording and feedback of CPR process. The outcomes (cerebral performance category 1 or 2, good CPC) and survival to discharge) were compared between study period (2015–2016) and control period (2013–2014). ResultsOverall, 6201 and 6469 patients were included in the control period and the study period, respectively. During the post-intervention period, the proportion of OHCA patients who underwent three types of cardiopulmonary resuscitation programs increased significantly compared to those in the pre-intervention period. DACPR increased from 38.3% to 44.3%, MTR increased from 0.0% to 37.5%, and FCPR increased from 25.3% to 61.5%. (All p values <0.001). Good neurological recovery and survival to discharge were significantly increased from 5.4% to 6.8%, and from 9.6% to 10.9%. The adjusted odds ratio (95% confidence intervals) of the study period was 1.45 (1.12–1.87) for good CPC, and 1.31 (1.09–1.58) for survival to discharge. ConclusionsThe citywide implementation of a bundle of UTIS CPR programs was associated with significantly better OHCA outcomes.

Estimation of the variations in mechanical impedance between the actuator and the chest, and the power delivered to the chest during cardiopulmonary resuscitation using machine-embedded sensors

BackgroundTo reduce the risk of patient damage and complications during the cardiopulmonary resuscitation (CPR) process in emergency situations, it is necessary to monitor the status of the patient and the quality of CPR while CPR processing without additional bio-signal measurement devices. In this study, an algorithm is proposed to estimate the mechanical impedance (MI) between an actuator of the CPR machine and the chest of the patient, and to estimate the power delivered to the chest of the patient during the CPR process.MethodsTwo sensors for force and depth measurement were embedded into a custom-made CPR machine and the algorithm for MI and power estimation was implemented. The performance of the algorithm was evaluated by comparing the results from the kinetic model, the conventional discrete Fourier transform (DFT), and the proposed method.ResultsThe estimations of the proposed method showed similar increasing/decreasing trends with the calculations from the kinetic model. In addition, the proposed method showed statistically equivalent performance in the MI estimation, and at the same time, showed statistically superior performance in the power estimation compared with the calculations from the conventional DFT. Furthermore, the MI and power estimation could be performed almost in real-time during the CPR process without excessive hands-off periods, and the intensity of random noise contained in the input signals did not seriously affect the MI and power estimations of the proposed method.ConclusionWe expect that the proposed algorithm can reduce various CPR-related complications and improve patient safety.

Ventilation strategies during out-of-hospital cardiac arrest: a problem that should not be neglected

The ventilation strategies of cardiopulmonary resuscitation (CPR) in patients out-of-hospital cardiac arrest (OHCA) is very important and has received more attention. In the past 10 years, many researches have focused on how to adjust the ratio and time of compression ventilation, minimize the frequency and times of chest compression interruption, and improve the success rate of restoration of spontaneous circulation (ROSC). The ventilation strategies that no ventilation and hyperventilation in the process of CPR are not supported by recent researches for their drawbacks and controversies, but passive ventilation (delayed ventilation) is strongly supported by a great deal of researches. There is debate about whether the use of advanced airway is recommended during the CPR process. How to define the best tidal volume, respiratory rate and fraction of inspired oxygen in CPR to ensure the best ratio of ventilation and blood flow will be the focus and difficulty of investigating ventilation strategies during CPR in further study.

Progress of mechanical ventilation during cardiopulmonary resuscitation

Mechanical ventilation is regarded as an effective means of replacing artificial ventilation during cardiopulmonary resuscitation (CPR), and has been widely used in the treatment of cardiac arrest (CA) patients. However, there are still some controversial issues remaining to be settled, such as the assessment of the effectiveness of mechanical ventilation, the selection of the optimal oxygen concentration (FiO2), tidal volume (VT), respiratory frequency, and mode of ventilation during the CPR process. The pros and cons of positive pressure ventilation are also inconclusive. We reviewed and summarized the related research in recent years, and recommended that the intermittent positive pressure ventilation (IPPV) of volume controlled with small VT (6-7 mL/kg), low ventilation rates (10 times/min), and pure oxygen could be applied during the mechanical ventilation of CPR. The best mechanical ventilation strategy still needs further experimental researches to discover and explore.