Cardiopulmonary Resuscitation Research Articles

Evaluation of a Pediatric Residents' Procedural Sedation Training Program: Feasibility, Quality, and Complication Rate.

Procedural sedation (PS) became a crucial component of pediatric care in the late 20th century, necessitating an effective and safe balance. Due to growing demand, it is often performed by pediatric residents, sometimes without formal training. The study aimed to assess the quality and complication rates of a pediatric residents' PS training program. This is a retrospective analysis of all pediatric PSs (aged 1 to 18 years) treated by pediatric residents alone or with staff physicians' supervision (Pediatric-Emergency-Care-Specialists or Intensive-Care-Specialists) in our general hospitals' pediatric PS qualification program (November 2017 to July 2021). PS data, including the reason for sedation, course, drugs, and complications, were collected and analyzed. Major complications were defined as the need for positive-pressure ventilation, laryngospasm, cardiopulmonary resuscitation, or unplanned admission. In all, 3156 PSs were performed, 1386 (43.9%) were conducted by sedation-trained pediatric residents and 1770 (56.1%) with staff physicians' supervision. All the sedations were successful. The percentage of sedations performed by pediatric residents alone increased annually. Midazolam was used in 1652 (52.3%) PSs, ketamine in 1080 (34.2%), and a midazolam-ketamine combination in 943 cases (29.9%). In 3107 (98.4%), PS had no adverse events. Mild adverse events were reported in 50/3156 (1.6%) of the PS with need for airway repositioning (27 cases, 0.9%), intranasal-O2 (13, 0.4%), mild hypoxia (12, 0.4%), suction (9, 0.3%), and intravenous fluids (3, 0.1%). There was only 1 hospital admission due to prolonged recovery. By multivariate analysis, slightly higher odds ratio (OR) for mild adverse event was found among patients with any chronic disease (OR=2.48, 95% CI: 1.20-5.14, P=0.014), and PS performed by pediatric residents alone versus pediatric residents guided by staff physicians (OR=2.26, 95% CI: 1.23-4.13, P=0.008). These findings highlight the feasibility of a PS service led by trained pediatric residents, as confirmed by the high PS success rate and 98.4% rate of no adverse reactions.

Dobutamine Use in Patients With Extracorporeal Cardiopulmonary Resuscitation Following Out-of-Hospital Cardiac Arrest: A Secondary Analysis of the SAVE-J II Study.

The effects of dobutamine on outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA), treated with extracorporeal cardiopulmonary resuscitation (ECPR), remain unclear. In this study, we aimed to evaluate the association between dobutamine use within 24 h and clinical outcomes in patients with OHCA who underwent ECPR. A post hoc analysis was conducted on the registry data from the SAVE-J II study (2013-2018). To address potential confounding variables related to dobutamine administration, 1:3 propensity score matching was employed using the patients' baseline characteristics. Following the matching, the dobutamine and non-dobutamine groups were compared, focusing on in-hospital mortality and neurological outcomes assessed using the cerebral performance category (CPC) scale. Of the 2157 registered cases, 581 cases of cardiogenic OHCA treated with targeted temperature management were included in this analysis. Eighty-eight patients who received dobutamine were compared with 264 who did not after propensity score matching. The in-hospital mortality rate was 60.2% in the dobutamine group, compared with 58.3% in the non-dobutamine group (p = 0.80). The proportion of patients with a CPC score of 3-5 at hospital discharge was 79.5% in the dobutamine group, compared with 78.0% in the non-dobutamine group (p = 0.88). A Kaplan-Meier analysis demonstrated no significant differences in survival rates between the two groups (42.1 vs. 43.6%, log-rank p = 0.79). In patients with OHCA who underwent ECPR, dobutamine administration within 24 h was not significantly associated with in-hospital mortality and neurological outcomes.

Clinical Profile and Neurological Outcomes of Pediatric Patients Supported on Venoarterial Extracorporeal Mechanical Oxygenation in a Cardiorespiratory Pediatric Intensive Care Unit: A Single-Center Study.

Extracorporeal membrane oxygenation (ECMO) has become a standard therapy in extremely sick patients for various indications. This rising use of ECMO warrants careful consideration of its neurological effects. Our single-center retrospective study, conducted between January 2016 and December 2022, on children ≤16 years, aimed to identify clinical and biochemical parameters associated with adverse neurological complications (ANC) on venoarterial ECMO (VA-ECMO), and its impact on their morbidity and mortality. Of 91 VA-ECMO runs analyzed, 37% were extracorporeal cardiopulmonary resuscitation (ECPR) recipients. Adverse neurological complications were diagnosed in 26% of patients during their ECMO run, and in 21% post-decannulation, for a total of 47% of the cohort. Overall, neck cannulation (p = 0.049), lower pre-ECMO pH (p = 0.018), higher pre-ECMO lactate (p < 0.001), delayed lactate clearance (p = 0.002), and progressive multiorgan dysfunction (p = 0.018) was associated with ANC. The absence of ANC conferred better survival to decannulation and quality of function status. Sub-analysis on ECPR recipients noted that longer time to cannulation (p = 0.023), lower pre-ECMO pH (p = 0.006), higher pre-ECMO lactate (p = 0.006), and delayed lactate clearance (p = 0.024) had higher ANC. At hospital discharge, 78.6% of survivors, including 91% of ECPR survivors had favorable neurological outcomes. Point-of-care testing combined with standard neuromonitoring may help identify and prognosticate ECMO recipients.

AI-ML Integrated WSN Devices in Capnography and Hypoxia: Role in Preventive Cardiology During Medical and Surgical Interventions

Applications of AI and ML are expanding, exponentially in critical medical diagnosis. Deep learning has proven its prominence in population health. It has a distinct role in disease risk prediction. Both AI and ML are enhancing recognition of out-of-hospital cardiac arrests. Wireless Sensor Networks (WSNs) and IOT (Internet of things) are being increasingly integrated in health vitals monitoring in critical medical emergencies. Use of wireless sensor networks (WSN) with computational capabilities to monitor carbon dioxide levels (capnography) and hypoxia during per-operative general anesthesia while using an anesthesia machine in delivering mixture of anesthesia gases in critical surgeries can prevent medical emergencies. Wireless Medical Sensors are brought in intimate contact with body to collect critical physiological data. Modern Continuous anesthesia delivery machine administers a mixture of anesthetic gases. Real time monitoring of developing hypoxia with EEG, febrile condition, Blood pressure, rate of heart beat, convoluted carbon dioxide as an indicator of depth of anesthesia can be of immense use to help anesthesiologists plan a safer anesthesia. In case of a cardiac arrest, CO2 produced at the level of tissues fails to get transported to lungs. Here is where the elimination of CO2 takes occurs. In cardiopulmonary resuscitation estimation of that is produced in exhalation can be a guide in circulation assessment. In comparison to an electrocardiogram, blood pressure or pulse it serves better in diagnosis. It is generally Normoxia in a cardiac surgery decreases kidney injury. A sensors that is an attachment in a patient's body to gather patient's physiological data followed by concurrent wireless transmission of such data can be on circulated onto a Physicians portable device. In this publication, we make an attempt to achieve more insights into recent developments in Critical Medicine in particular applications focused on` how WSN and IOT can help maintain balanced Anesthesia with minimum cardiac arrest risk using a real time per-operative monitoring technique targeted towards hypoxia and end tidal carbon dioxide levels in blood.

Relationship between the use of the backboard and the quality of chest compressions.

Relationship between the use of the backboard and the quality of chest compressions.

Cardiac Arrest in Outpatient Hemodialysis Units: A National Cross-Sectional Survey of Dialysis Technicians.

Cardiac Arrest in Outpatient Hemodialysis Units: A National Cross-Sectional Survey of Dialysis Technicians.

Educational strategies and technologies for promoting knowledge, attitude, and practice of children on cardiopulmonary resuscitation: A systematic review.

Educational strategies and technologies for promoting knowledge, attitude, and practice of children on cardiopulmonary resuscitation: A systematic review.

Splenic modulation of the early inflammatory response to regional and global ischemia/reperfusion injury in swine.

The spleen has been identified as a source of proinflammatory leukocytes mobilized after local ischemic injury in rodents. However, the role of the spleen in the inflammatory response to regional or global ischemia/reperfusion injury (IRI) in larger mammals is unknown. We investigated the spleen's contribution to early IRI-associated inflammation in porcine models of acute reperfused myocardial infarction (AMI) and sudden cardiac arrest (SCA). Swine were randomized to splenectomy (SPLX; n = 15) or sham surgery (SHAM; n = 15) 1 wk before a 75 min coronary occlusion (AMI; n = 6/group) or 8 min of ventricular fibrillation and cardiopulmonary resuscitation (CPR) (SCA; n = 9/group). Hemodynamic assessment and echocardiography were performed before and after IRI, with serial blood sampling to assess leukocyte mobilization and cytokine release. Heart and brain samples were collected for postmortem evaluation of injury and leukocyte infiltration. Early post-IRI leukocyte mobilization, cytokine levels, and leukocyte infiltration were similar between groups in each protocol. After SCA, SHAM animals showed a significant 41 ± 15% increase in hematocrit and 30 ± 12% rise in arterial O2 content during CPR that was absent after SPLX. These differences persisted for up to 90 min and were associated with prolonged time to return of spontaneous circulation (ROSC) and increased vasopressor support in the SPLX group. Contrary to findings in rodents, the spleen is not required for the early inflammatory response to regional or global IRI in swine. However, splenic erythrocyte mobilization during SCA leads to an increase in arterial O2 content that is associated with earlier ROSC and reduced reliance on vasopressors during CPR and the postresuscitation period.NEW & NOTEWORTHY Acute reperfused myocardial infarction (AMI) and sudden cardiac arrest (SCA) are characterized by ischemia-reperfusion injury (IRI) and inflammation. Although prior studies implicated the spleen as a primary source of inflammatory leukocytes after regional IRI in rodents, our findings indicate that, in swine, the spleen is not required for leukocyte mobilization after AMI or SCA. However, splenic erythrocyte mobilization during whole body IRI increases arterial oxygen content during CPR and may influence outcomes after SCA.

Critical care nurses' responses to clinical scenarios involving cardiopulmonary resuscitation for deceased inpatients without a Do Not Resuscitate order: A cross-sectional study.

Critical care nurses' responses to clinical scenarios involving cardiopulmonary resuscitation for deceased inpatients without a Do Not Resuscitate order: A cross-sectional study.

Physicians' opinion of patients' CPR decision: Secondary analysis from a pilot RCT.

Physicians' opinion of patients' CPR decision: Secondary analysis from a pilot RCT.

The impact of dispatcher-assisted CPR and prior bystander CPR training on neurologic outcomes in out-of-hospital cardiac arrest: a multicenter study.

The impact of dispatcher-assisted CPR and prior bystander CPR training on neurologic outcomes in out-of-hospital cardiac arrest: a multicenter study.

Impact of smartphone activated first responders on provision of bystander CPR, bystander AED and outcomes for out-of-hospital cardiac arrest (OHCA).

Impact of smartphone activated first responders on provision of bystander CPR, bystander AED and outcomes for out-of-hospital cardiac arrest (OHCA).

A Randomized Crossover Simulation Study of Prolonged Conventional Versus Modified "Koch" Chest Compressions in a Height-Restricted Setting.

A Randomized Crossover Simulation Study of Prolonged Conventional Versus Modified "Koch" Chest Compressions in a Height-Restricted Setting.

Emergency medicine updates: Cardiopulmonary resuscitation.

Emergency medicine updates: Cardiopulmonary resuscitation.

Chest compression quality and retention of skills in basic life support training given to medical school year 5 students

OBJECTIVES: Sudden cardiac arrest is a significant cause of cardiovascular death. Basic life support (BLS) practitioners need training to provide effective, quality interventions. This study investigates the effectiveness of curriculum-based BLS training and measures the students’ performance levels before and after training and their skill retention over time. METHODS: A total of 70 students were selected as the study population. Before their emergency medicine (EM) clerkship, participants performed BLS with 30 compressions and two rescue breaths on a simulation manikin (Measurement 1). Early posttraining skills were reassessed within the 1st week after clerkship (Measurement 2), and skill retention was evaluated after 9 months (Measurement 3). All measurements were done by a single observer using the same manikin. RESULTS: Of the 70 enrolled students, 64 completed the study. Significant improvements were observed in overall cardiopulmonary resuscitation (CPR), compression, and ventilation scores posttraining and at 9 months (P &lt; 0.05). Among 34 participants who performed ≥3 CPRs, posttraining and 9-month scores remained stable (P = 0.238). No significant change was found in compression scores among nonperformers (P = 0.982), and intergroup comparisons showed no statistical difference (P = 0.977; P = 0.900). CONCLUSION: BLS training provided to medical faculty 5th-year students in the EM clerkship program increased the effectiveness of chest compression, and this skill did not regress within 9 months.

Evaluating the Preparedness of Healthcare Providers for Prone Position CPR Across Jordan's Healthcare Sectors: A Descriptive Cross-Sectional Study.

Healthcare providers may need to initiate cardiopulmonary resuscitation (CPR) while patients are in the prone position. Healthcare providers (HCPs) must possess the necessary knowledge, skills, and experience to perform cardiopulmonary resuscitation in the prone position (PPCPR) confidently. This study aimed to assess HCPs' preparedness to perform cardiopulmonary resuscitation in the prone position at specialized units in Jordan's healthcare sectors. In eight tertiary hospitals, a descriptive cross-sectional survey was carried out. An online questionnaire was conducted among 332 HCPs who were employed in the operating room, intensive care units, or interventional procedure rooms. The majority of HCPs (73%) exhibited poor preparedness, with only 25% showing excellent preparedness, and 2% displayed an average level of preparedness. The average preparedness score was 37.14 (SD = 38.840), indicating significant variability. A lack of targeted training was associated with lower preparedness levels. Notably, HCPs with Advanced Cardiac Life Support (ACLS) training showed significantly higher preparedness. The HCPs in Jordan are poorly prepared to perform PPCPR whenever required. However, the study findings represent a significant step towards improving HCPs' preparedness to perform PPCPR. They serve as a baseline assessment and highlight the gaps in HCPs' readiness, which helps their organizations to develop and implement targeted training strategies and interventions. Incorporating this training into hospital orientation, training programs, and clinical guidelines is vitally important to enhance HCPs' capabilities for better outcomes.

Real-time hemodynamic responses to epinephrine and their association with ROSC in out-of-hospital cardiac arrest.

Real-time hemodynamic responses to epinephrine and their association with ROSC in out-of-hospital cardiac arrest.

Impact of rescuer position, arm angle, and anthropometric variables on muscle fatigue during cardiopulmonary resuscitation: an international multicentric randomized crossover simulation study.

Impact of rescuer position, arm angle, and anthropometric variables on muscle fatigue during cardiopulmonary resuscitation: an international multicentric randomized crossover simulation study.

Ethical decisions on the end of life during internal medicine on-call shifts.

Ethical decisions on the end of life during internal medicine on-call shifts.

Differences in the Usability of Fully Automated External Defibrillators between Medical and Nonmedical Professionals

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.