Cardiopulmonary Resuscitation Scenario Research Articles

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

Effective ventilation and chest compressions during neonatal resuscitation – the role of the respiratory device

Background The success of cardiopulmonary resuscitation (CPR) in newborns largely depends on effective lung ventilation; however, a direct randomized comparison using different available devices has not yet been performed. Methods Thirty-six professionals were exposed to a realistic newborn CPR scenario. Ventilation with either a bag-valve mask (BVM), T-piece, or ventilator was applied in a randomized manner during CPR using a Laerdal manikin. The primary outcome was the number of unimpaired inflations, defined as the peak of the inflation occurring after chest compression and lasting at least 0.35 s before the following chest compression takes place. The secondary outcomes were tidal volume delivered and heart compression rate. To simulate potential distractions, the entire scenario was performed with or without a quiz. Statistically, a mixed model assessing fixed effects for experience, profession, device, and distraction was used to analyze the data. For direct comparison, one-way ANOVA with Bonferroni‘s correction was applied. Results The number of unimpaired inflations was highest in health care professionals using the BVM with a mean ± standard deviation of 12.8 ± 2.8 (target: 15 within 30 s). However, the tidal volumes were too large in this group with a tidal volume of 42.5 ± 10.9 ml (target: 25–30 ml). The number of unimpaired breaths with the mechanical ventilator and the T-piece system were 11.6 (±3.6) and 10.1 (±3.7), respectively. Distraction did not change these outcomes, except for the significantly lower tidal volumes with the T-piece during the quiz. Conclusions In summary, for our health care professionals, ventilation using the mechanical ventilator seemed to provide the best approach during CPR, especially in a population of preterm infants prone to volutrauma.

Non-technical Skills in Cardiopulmonary Resuscitation: Improvement and Evaluation of a New Course Introduced to the Curriculum at a Medical School in Poland in 2018 to 2019

Non-technical skills (NTS) are important skills in emergency medicine and should be a necessity even at the stage of medical studies. The aim of this study was to assess how increasing the number of non-technical skills hours influenced the results of non-technical competences among medical students. In this investigation, 296 Polish medical students in the sixth year at Medical College in Krakow, Poland were included in the study. The students were divided into two research groups: I in 2018 and II in 2019. The groups differed in the number of total hours that focused on non-technical skills, in 2018: 60 hr, and 2019: 120 total hours. Non-technical competencies were assessed at the Crisis Resource Management station using sudden cardiac arrest scenarios. In 2018, the median was 20 points and the average of the points obtained in this group was 19.53 points (SD 5.39 points). In 2019, the median was 26 points and the average of points was 25.07 points (SD 5.23 points). Students who had more non-technical skills classes (120 hr) scored more points on the OSCE exam than group I (60 hr) ( p < .001). The median of points in non-technical competences depended on the number of teaching hours in which the main emphasis was on the development of these skills. This investigation demonstrates that more teaching hours dedicated to improving the non-technical skills of students corresponded to better results on the cardiopulmonary resuscitation scenarios.

Impact of emergency management in a simulated home environment for caregivers of children who are tracheostomy dependent.

Children who are tracheostomy dependent require comprehensive caregiver preparation for safe hospital-to-home transition. Although a structured discharge education program successfully trained caregivers to provide routine daily tracheostomy care, emergency response training was limited, lacking realistic experiences. Initiation of simulated emergency training for caregivers indicated performance confusion related to tracheostomy cardiopulmonary resuscitation (CPR). This study evaluated the effectiveness of an evidence-based tracheostomy CPR education intervention via caregiver participation in a high-fidelity simulation of a home-based emergency scenario on the performance of essential behaviors, comfort, and satisfaction. The study utilized a prospective descriptive pre- and post interventional design; 44 caregivers of children who were tracheostomy dependent participated. All caregiver participants completed: video- and instructor-assisted specialized tracheostomy CPR class, high-fidelity simulation performance of a home-based emergency (respiratory failure with cardiac arrest), postsimulation video debriefing, performance assessment with an objective scoring rubric, and pre- and post simulation surveys on levels of comfort and satisfaction. On the performance of essential emergency management behaviors, 86.4% of caregivers performed all four behaviors, but only 36.4% performed these essential behaviors in order. Post simulation caregiver comfort with emergency management significantly increased from pre simulation (p = .001). All caregivers were satisfied with this training and would recommend simulation of home-based emergencies for all caregivers. Qualitative feedback from caregivers revealed themes of gratitude and the importance of hands-on practice with guided debriefing/feedback. Study power was 0.98. Objective evaluation of caregiver performance demonstrated specialized tracheostomy CPR education prepared caregivers to respond in a home emergency. Caregivers viewed simulation as an opportunity to gain hands-on experience and improve emergency responses. It may be beneficial for other similar programs to include specialized tracheostomy CPR and emergency scenario simulation in their discharge education protocols and subsequently compare this program to other similar programs to establish best practice guidelines.

Development of a Mannequin for Simulation-Based Trials Involving Respiratory Viral Spread During Respiratory Arrest and Cardiopulmonary Arrest Scenarios.

During the coronavirus disease 2019 (COVID-19) pandemic, mannequin models have been developed to mimic viral spread using fluorescent particles. These models use contraptions such as a spray gun or an exploding latex balloon to emanate a sudden acceleration of particles, simulating a “cough” reflex. No models have been developed to mimic passive aerosolization of viral particles during a cardiopulmonary arrest simulation. Our novel approach to aerosolization of simulated viral spread allows for a continuous flow of particles, which allows us to maintain components of high-fidelity team-based simulations. Our simulated model emanated GloGerm (Moab, UT) from the respiratory tract using a continuous nebulization chamber. Uniquely, the construction of our apparatus allowed for the ability to perform full, simulated cardiopulmonary resuscitation scenarios (such as chest compressions, bag-mask ventilation, and endotracheal intubation) on a high-fidelity mannequin while visualizing potential contamination spread at the conclusion of the simulation.Positive feedback from users included the ability to visualize particulate contamination after cardiopulmonary resuscitations in the context of personal protective equipment usage and roles in resuscitation (i.e. physician, respiratory therapist, nurse). Negative criticism towards the simulation included the lack of certain high-fidelity feedback markers of the mannequin (auscultating breath sounds and checking pulses) due to the construction of the particle aerosolization mechanism.

Just showing is not enough: First-person-view-videos as a feedback tool in resuscitation simulation

Theory and evidence suggest beneficial effects of integrating first-person-view (FPV) videos as a feedback method in resuscitation simulation training. However, systematic research on this instructional approach is scarce. We aimed to determine the feasibility of supplementing feedback with FPV videos for simulation-based learning and its effect on cardiopulmonary resuscitation (CPR) performance. In our randomized controlled trial conducted in a simulation-based course on CPR, each participant’s FPV video was recorded using a head-mounted camera and videos were shown before post-simulation debriefing. Feasibility was tested in 27 simulated CPR scenarios randomized to FPV feedback combined with instructor-led debriefing (intervention; 14 scenarios) versus instructor-led debriefing only (control; 13 scenarios). In terms of CPR (effective compression ratio [ECR]) and team performance (Team Emergency Assessment Measure [TEAM]), improvements were observed for ECR (pre-test: 0.13 ± 0.11 vs post-test 0.19 ± 0.11) and TEAM score (pre-test: 16.6 ± 7.2 vs post-test: 25.4 ± 9.2). However, improvements did not differ significantly between intervention and control group. Course participants deemed the feedback method feasible and reported positive instructional effects. In order to make use of the potential of this promising feedback tool, we conclude that it is not sufficient to show the videos without didactical assistance.

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.

CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial

BackgroundThe aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position.MethodsIn this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position.ResultsOnly 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s.ConclusionsEfficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.

Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation

Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking. To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76). The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria. Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects. In total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%]; mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P < .001), the mean time to drug preparation decreased by 40 seconds (95% CI, 23-57 seconds; P < .001), and the mean time to drug delivery decreased by 47 seconds (95% CI, 27-66 seconds; P < .001). The risk of medication errors varied across drugs with conventional methods (19.7%-100%) when compared with the app (4.1%-6.8%). Compared with conventional methods, the use of a mobile app significantly decreased the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting. Dedicated mobile apps have the potential to improve medication safety and change practices in pediatric emergency medicine. ClinicalTrials.gov Identifier: NCT03921346.

Comparison of cardiopulmonary resuscitation that applied synchronous 30 compressions–2 ventilations with that applied asynchronous 110/min compression–10/min ventilation: A mannequin study

Background: CPR model of a resuscitation to be ventilated with a bag valve mask constitutes a discussion when evaluated with the current guidance. Objective: This study aims to compare the synchronous (30–2) ventilation–compression method with asynchronous 110/min compression–10/min ventilation in cardiac arrests where an advanced airway management is not applied and where ventilation is provided by a bag valve mask on a mannequin. Methods: This simulation trial was performed using two clinical cardiopulmonary resuscitation scenarios: an asynchronous scenario with 10 ventilations per minute asynchronously when compression is applied as 110 compression per minute and a synchronous scenario in which 30 compressions:2 ventilations were performed synchronously. A total of 100 people in 50 groups applied these two scenarios on mannequin. Ventilation and compression data of both scenarios were recorded. Results: Evaluating the compression criteria in both the scenarios performed by 50 groups in total, in terms of all criteria except compression fraction, there was no statistically difference between the two scenarios (p &gt; 0.05). Compression fraction values in the asynchronous scenario were found to be statistically significantly higher than the synchronous scenario (96.02 ± 2.35, 81.34 ± 4.42, p &lt; 0.001). Evaluating the ventilation criteria in both the scenarios performed by 50 groups in total; there was a statistically significant difference in all criteria. Mean ventilation rate of the asynchronous scenario was statistically higher than the synchronous scenario (7.22 ± 2.42, 5.08 ± 0.75, p &lt; 0.001). Mean ventilation volume of the synchronous scenario was statistically higher than the asynchronous scenario (353.24 ± 45.46, 527.40 ± 96.60, p &lt; 0.001). Ventilation ratio in sufficient volume of the synchronous scenario was statistically higher than the asynchronous scenario (36.84 ± 14.47, 75.00 ± 21.24, p &lt; 0.001). Ventilation ratio below the minimum volume limit of the asynchronous scenario was statistically higher than the synchronous scenario (62.48 ± 14.72, 17.86 ± 19.50, p &lt; 0.001). Conclusion: In our study, we concluded that the cardiopulmonary resuscitation applied by the synchronous method reached better ventilation volumes. Evaluating together with any interruption in compression, comprehensive studies are needed to reveal which patients would benefit from this result.

Validating peer-led assessments of CPR performance

BackgroundA patient’s survival from cardiac arrest is improved if they receive good quality chest compressions as soon as possible. During cardiopulmonary resuscitation (CPR) training subjective assessments of chest compression quality is still common. Recently manikins allowing objective assessment have demonstrated a degree of variance with Instructor assessment. The aim of this study was to compare peer-led subjective assessment of chest compressions in three groups of participants with objective data from a manikin. MethodThis was a quantitative multi-center study using data from simulated CPR scenarios. Seventy-eight Instructors were recruited, from different backgrounds; lay persons, hospital staff and emergency services personnel. Each group consisted of 13 pairs and all performed 2 ​min of chest compressions contemporaneously by peers and manikin (Brayden PRO®). The primary hypothesis was subjective and objective assessment methods would produce different test outcomes. Results13,227 chest compressions were assessed. The overall median score given by the manikin was 88.5% (interquartile range 71.75–95), versus 92% (interquartile range 86.75–98) by observers. There was poor correlation in scores between assessment methods (Kappa −0.051 – +0.07). Individual assessment of components within the manikin scores demonstrated good internal consistency (alpha ​= ​0.789) compared to observer scores (alpha ​= ​0.011). ConclusionObservers from all backgrounds were consistently more generous in their assessment when compared to the manikin. Chest compressions quality influences outcome following cardiac arrest, the findings of this study support increased use of objective assessment at the earliest opportunity, irrespective of background.

EFFECTS OF FEEDBACK NN SKILLS DURING CARDIOPULMONAL REANIMATION TRAINING

Sudden cardiac arrest is one of the main causes of death in Europe. Early initiation and qualitative performance of cardiopulmonary resuscitation can reduce mortality. In order to perform cardio-pulmonary resuscitation of appropriate quality, theoretical and practical knowledge is needed which can be improved by clinical simulation. The aim of the study was to find out the effect of feedback on participants' skills during cardiopulmonary resuscitation training. Hypothesis - feedback improves participants' skills during cardiopulmonary resuscitation training. Research Method - randomized controlled simulation study. Research instruments - observation protocol, questionnaire. A total of 32 employees of State Emergency Medical Service (medical practitioners) participated in the study. The hypothesis was confirmed - feedback improves participants' skills during cardiopulmonary resuscitation training. The total evaluation of cardiopulmonary resuscitation in the intervention group, which performed the cardiopulmonary resuscitation scenario with the feedback function is higher (92,13%) compared to the control group (77%). Most of the participants in the intervention group fully agree that the use of feedback function during training improves the overall cardiopulmonary resuscitation skills. The results of the study indicate that the development of cardiopulmonary resuscitation training programs for medical students and practitioners requires the inclusion of practical activities with clinical simulations with feedback.

Cardiopulmonary resuscitation in television medical dramas: Results of the TVMD2 study.

Television medical dramas (TVMDs) use cardiopulmonary resuscitation (CPR) as a mean of achieving higher viewing rates. TVMDs portrayal of CPR can be used to teach laypersons attempting to perform CPR and to form a shared professional and layperson mental model for CPR decisions. We studied the portrayal of CPR across a wide range of TVMDs to see whether newer series fulfill this promise. Advanced cardiac life support (ACLS) certified healthcare providers underwent training in the use of a unique instrument based on the AHA (American Heart Association) guidelines to assess TVMD CPR scenarios. Components of the assessment included the adequacy of CPR techniques, gender distribution in CPR scenes, performance quality by different healthcare providers, and CPR outcomes. Thirty-one TVMDs created between 2010 and 2018 underwent review. Among 836 TVMD episodes reviewed, we identified 216 CPR attempts. CPR techniques were mostly portrayed inaccurately. The recommended compressions depth was shown in only 32.0% of the attempts (n=62). The recommended rate was shown in only 44.3% of the attempts (n=86). Survival to hospital discharge was portrayed as twice higher in male patients (67.6%, n=71) than in female patients (32.4%, n=29) (p<0.05). Paramedics were portrayed as having better performance than physicians or nurses; compression rates were shown to be within the recommendations in only 42% (n=73) of the CPR attempts performed by physicians, 44% (n=8) of those performed by nurses, and 64% (n=9) of those performed by paramedics. Complete chest recoil after compression was shown in only 34% (n=58) of the CPR attempts performed by physicians, 38% (n=7) of those performed by nurses, and 64% (n=9) of those performed by paramedics. Outcomes were better on the screen than in real life; among the episodes showing outcome (n=202), the overall rate of survival from CPR was 61.9% (n=125). Portrayal of CPR in TVMDs remains a missed opportunity for improving performance and communication on CPR.

Standardising communication to improve in-hospital cardiopulmonary resuscitation

AimRecommendations for standardised communication to reduce chest compression (CC) pauses are lacking. We aimed to achieve consensus and evaluate feasibility and efficacy using standardised communication during cardiopulmonary resuscitation (CPR) events. MethodsModified Delphi consensus process to design standardised communication elements. Feasibility was pilot tested in 16 simulated CPR scenarios (8 scenarios with physician team leaders and 8 with chest compressors) randomized (1:1) to standardised [INTERVENTION] vs. closed-loop communication [CONTROL]. Adherence and efficacy (duration of CC pauses for defibrillation, intubation, rhythm check) was assessed by audiovisual recording. Mental demand and frustration were assessed by NASA task load index subscales. ResultsConsensus elements for standardised communication included: 1) team preparation 15−30 s before CC interruption, 2) pre-interruption countdown synchronized with last 5 CCs, 3) specific action words for defibrillation, intubation, and interrupting/resuming CCs. Median (Q1,Q3) adherence to standardised phrases was 98% (80%,100%). Efficacy analysis showed a median [Q1,Q3] peri-shock pause of 5.1 s. [4.4; 5.8] vs. 7.5 s. [6.3; 8.8] seconds, p < 0.001, intubation pause of 3.8 s. [3.6; 5.0] vs. 6.9 s. [4.8; 10.1] seconds, p = 0.03, rhythm check pause of 4.2 [3.2,5.7] vs. 8.6 [5.0,10.5] seconds, p < 0.001, median frustration index of 10/100 [5,20] vs. 35/100 [25,50], p < 0.001, and median mental demand load of 55/100 [30,70] vs. 65/100 [50,85], p = 0.41 for standardised vs. closed loop communication. ConclusionThis pilot study demonstrated feasibility of using consensus-based standardised communication that was associated with shorter CC pauses for defibrillation, intubation, and rhythm checks without increasing frustration index or mental demand compared to current best practice, closed loop communication.

Abstract 247: Development and Evaluation of Standardized Communication for In-Hospital Resuscitation

Background: Recommendations for “standardized” communication during cardiopulmonary resuscitation (CPR) events to reduce interruptions in chest compressions (CCs) are lacking. We aimed to achieve consensus on standardized communication during in-hospital CPR, evaluate feasibility and potential to decrease CC pauses, mental task load, and frustration. Methods: Modified Delphi consensus surveys of International Liaison Committee on Resuscitation taskforce members to identify preferred communication for in-hospital cardiac arrest teams. Consensus was reached after-survey teleconference resolution by a team of interdisciplinary experts in communication and CPR. Feasibility was tested in 8 simulated CPR scenarios with physician team leaders randomized (1:1) to ‘standardized’ communication vs. “usual best practice”, closed loop communication. Team leaders watched a 3-min video and received a 10-min training on the assigned intervention before the CPR scenario. NASA task load index questionnaires were used to assess mental task load and frustration (0=lowest to 100=highest). Results: Modified Delphi consensus on standardized communication included: 1) preparing the team 15-30 seconds before interrupting CCs, 2) countdown for interruption synchronized with 5 CCs, 3) action words for stopping and resuming CCs, 4) action words for intubation and defibrillation. Among 8 CPR teams (4 standardized, 4 usual communication), median (Q1; Q3) CC interruption duration for rhythm check was significantly shorter, 5.3 (4.8; 6.8) vs. 9.4 (6.4; 13.0) sec for standardized vs. closed loop communication [p=0.02]. Median (Q1; Q3) scores of mental task load were 63 (33; 70) vs 85 (70; 96), [p=0.10] and frustration 10 (5; 34) vs 40 (26; 50) [p=0.11] for standardized vs. closed loop communication. Trained team leaders adhered to standardized phrases 77% of the time. Conclusion: Expert consensus for standardized communication during in-hospital CPR was achieved. Pilot simulation implementation of standardized communication demonstrated feasibility of team leader adherence, significantly decreased duration of CC interruption during rhythm checks, and a tendency to reduce team leader task load and frustration.

Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality

Bystander cardiopulmonary resuscitation (CPR) is crucial for survival after cardiac arrest but not performed in most cases. New, low-cost, and easily accessible training methods, such as virtual reality (VR), may reach broader target populations, but data on achieved CPR skills are lacking. To compare CPR quality between VR and face-to-face CPR training. Randomized noninferiority trial with a prospective randomized open blinded end point design. Participants were adult attendees from the science section of the Lowlands Music Festival (August 16 to 18, 2019) in the Netherlands. Analysis began September 2019. Two standardized 20-minute protocols on CPR and automated external defibrillator use: instructor-led face-to-face training or VR training using a smartphone app endorsed by the Resuscitation Council (United Kingdom). During a standardized CPR scenario following the training, we assessed the primary outcome CPR quality, measured as chest compression depth and rate using CPR manikins. Overall CPR performance was assessed by examiners, blinded for study groups, using a European Resuscitation Council-endorsed checklist (maximum score, 13). Additional secondary outcomes were chest compression fraction, proportions of participants with mean depth (50 mm-60 mm) or rate (100 min-1-120 min-1) within guideline ranges, and proportions compressions with full release. A total of 381 participants were randomized: 216 women (57%); median (interquartile range [IQR]) age, 26 (22-31) years. The VR app (n = 190 [49.9%]) was inferior to face-to-face training (n = 191 [50.1%]) for chest compression depth (mean [SD], VR: 49 [10] mm vs face to face: 57 [5] mm; mean [95% CI] difference, -8 [-9 to -6] mm), and noninferior for chest compression rate (mean [SD]: VR: 114 [12] min-1 vs face to face: 109 [12] min-1; mean [95% CI] difference, 6 [3 to 8] min-1). The VR group had lower overall CPR performance scores (median [IQR], 10 [8-12] vs 12 [12-13]; P < .001). Chest compression fraction (median [IQR], 61% [52%-66%] vs 67% [62%-71%]; P < .001) and proportions of participants fulfilling depth (51% [n = 89] vs 75% [n = 133], P < .001) and rate (50% [n = 87] vs 63% [n = 111], P = .01) requirements were also lower in the VR group. The proportion of compressions with full release was higher in the VR group (median [IQR], 98% [59%-100%] vs 88% [55%-99%]; P = .002). In this randomized noninferiority trial, VR training resulted in comparable chest compression rate but inferior compression depth compared with face-to-face training. Given the potential of VR training to reach a larger target population, further development is needed to achieve the compression depth and overall CPR skills acquired by face-to-face training. ClinicalTrials.gov identifier: NCT04013633.

Rationale and design of the Lowlands Saves Lives trial: a randomised trial to compare CPR quality and long-term attitude towards CPR performance between face-to-face and virtual reality training with the Lifesaver VR app

IntroductionLayperson cardiopulmonary resuscitation (CPR) is a key aspect in the chain of survival after cardiac arrest. New, low-cost, easily accessible training methods such as virtual reality (VR) training with a...

OUTCOMES OF CARDIAC ARREST BETWEEN REALITY AND TELEVISION MEDICAL DRAMAS: RESULTS OF THE TVMD2 STUDY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Outcomes of cardiopulmonary resuscitation (CPR) include: death, return of spontaneous circulation (ROSC), sustained ROSC, and discharge from hospital, among others. We aimed to assess if television medical dramas (TVMDs) depictions of CPR outcomes are representative of reality. METHODS: An instrument was created to address quality of CPR in TVMD. It was applied by advanced cardiac life support (ACLS) certified-health care providers, to assess and review CPR scenarios performance and outcomes from 32 different TVMDs from 2010 to 2018. Data was evaluated to explore CPR outcomes. RESULTS: A total of 836 episodes of TVMDs were reviewed with a total of 212 on-screen CPR attempts; of which, 202 revealed the outcome. CPR success rate was 61.9% (n=125). In 189 CPR scenes, patient’s condition was followed during the hospitalization, and 54% (n=102) survived to hospital discharge. Of the survivors, we were able to assess the cerebral performance category (CPC) score in 88 patients. 96.5% (n=85) had favorable neurological outcome (CPC 1,2) and only 3.5% (n=3) had unfavorable neurological outcome (CPC 3,4 and5). Moreover, we assessed if determination of ROSC in TVMDs complied with the Utstein Resuscitation Registry Templates (by spontaneously restoring a palpable pulse or a measurable blood pressure). We found that from 160 episodes, in which we could assess how ROSC was determined, only 30% (n=48) depended on the pulse; while 56.3% (n=90) used the monitor. Other methods to identify ROSC were echocardiography in 3.75% (n=6), waking up in 9.38% (n=15), breathing in 4.38% (n=7), and coughing in 2.5% (n=4) of the patients. CONCLUSIONS: The success rate of CPR and neurological outcomes for survivors in TVMDs are better than outcomes among real patients. ROSC identification also varied from common clinical practice. TVMDs portrayal of CPR outcomes significantly misrepresents outcomes in reality. CLINICAL IMPLICATIONS: TVMDs are a major source of medical education among lay people. Inadequate representation of CPR outcomes may give families false hope. DISCLOSURES: No relevant relationships by Abbas Alshami, source=Web Response Advisory Committee Member relationship with Zoll Please note: $5001 - $20000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Travel<br Advisory Committee Member relationship with Medtronic Please note: $20001 - $100000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Intellectual property rights Advisory Committee Member relationship with Diasorin Please note: $1001 - $5000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Grant/Research Support No relevant relationships by Luz Ramirez, source=Web Response No relevant relationships by Joseph Varon, source=Web Response No relevant relationships by Daryelle Varon, source=Web Response

A new chest compression technique in infants

ObjectiveTo compare the quality of chest compressions performed according to the classical technique (MT) vs. a new technique (NM) (compression with 2 thumbs with closed fists) in an infant manikin. DesignA controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. SettingA University Hospital with a Pediatric ICU in the north of Spain. ParticipantsResidents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. InterventionsQuantitative analysis of the variables referred to chest compression quality in a 2-min cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad® with SkillReporter™ system was used. Main variables of interestMean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. ResultsGlobal quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [P=.25; P=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [P=.76; P=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [P=.06; P=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [P=.58; P=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [P=.13; P=ns]) proved similar with both methods. ConclusionsThe quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

Parental opinion of consent in neonatal research

BackgroundNeonatal research, particularly neonatal emergency research is a challenging area, notably in relation to obtaining valid prospective informed consent. The aim of this study is to determine parental perceptions of...