Basic Life Support Cardiopulmonary Resuscitation Research Articles

Abstract Su203: Development of Bioimpedance for the Measurement of Ventilation During Cardiopulmonary Resuscitation

Introduction: Previous studies have shown that ventilation during cardiopulmonary resuscitation (CPR) produces better patient outcomes. However, research regarding ventilation during the early stages of basic life support CPR is limited. Prior studies showed that thoracic bioimpedance, recorded by the LifePak 12 defibrillator device, can be used to count ventilations with a tidal volume at least 250 mL during CPR. However, the relationship between thoracic bioimpedance and tidal volume has yet to be studied for the Phillips MRx device, excluding a large data set from ventilation studies. Hypothesis: Bioimpedance, measured by the Phillips MRx device has a linear relationship with tidal volume. Aims: To determine the relationship between bioimpedance measured by the Phillips MRx device and tidal volume in males and females. Methods: We conducted the study in a respiratory laboratory at a University Hospital. We asked 27 volunteers to breathe fixed volumes (250 mL, 300 mL, 400 mL, 600 mL, and 800 mL) delivered by a mechanical ventilator while recording bioimpedance simultaneously with the Philips MRx monitor-defibrillator through electrode pads placed on the chest. Six measurements of bioimpedance waveform amplitudes (Ohms) were taken at each tidal volume. Results: Of 27 volunteers, 11 were female and 16 were male. In the female sample set, a linear equation of y=0.003x + 0.837 with an R^2 value of 0.9995 was calculated. In the male sample set, a linear equation of Y=0.0016x +0.1039 with a R^2 value of 0.995 was calculated. Females had a higher median bioimpedance amplitude than men at each tidal volume, and a steeper linear regression slope. At the minimum threshold tidal volume used for counting ventilations (250 mL), the median bioimpedance amplitude was 0.5 (0.4, 0.6) ohm for males and the median bioimpedance amplitude was 0.8 (0.6, 1) ohm for females. Conclusion: As measured and recorded with the Philips MRx monitor-defibrillator, there is a linear relationship between tidal volume and thoracic bioimpedance. The linear models created in this study can be used in future studies to count ventilations during CPR using the Philips MRx device.

Cardiopulmonary resuscitation: knowledge among nurses in selected departments of a teaching hospital, Nepal

Introduction: Cardiopulmonary Resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. If early basic life support CPR is instantiated, the survival rate is improved. This study aims to assess the knowledge regarding CPR among nurses. Method: A descriptive cross-sectional study design was adopted among 150 nurses in critical care area of Patan Hospital Lalitpur Nepal, from January to April 2023. Researcher developed self-administered structured questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences. Result: Study revealed that majority 143(95.3%) of the respondents had knowledge regarding meaning of sudden cardiac death. Same as 137(91.3%) knew the indication of CPR and most of the respondents 140(93.3%) knew the carotid pulse should be checked before starting CPR. More than half 131(87.3%) had knowledge regarding ratio of chest compression. We found more than half respondents 83(55.3%) knew the best time to switch. Nearly half of the respondents 61(40%) knew the component of high-quality CPR whereas minority of the respondents; 20(13.3%) knew the algorithm of adult cardiac arrest. Conclusion: Majority of the respondents had knowledge regarding meaning, indication, site of pulse taking, and ratio of chest compression. Whereas more than fifty percent respondents had knowledge regarding, best time to switch, nearly half of respondents knew the components of CPR. Minority of respondents aware the algorithm of adult cardiac arrest.

Influence of high altitude after a prior ascent on physical exhaustion during cardiopulmonary resuscitation: a randomised crossover alpine field experiment

BackgroundPerforming cardiopulmonary resuscitation (CPR) inevitably causes significant physical, as well as psychological stress for rescuers. Physical activity at high altitude, a hypobaric and hypoxic environment, similarly adds to the level of stress and causes multiple physiological changes. Continuous measurement of pulse rate serves as an objective measure of fatigue during CPR. We therefore aimed to investigate rescuers’ heart rates as a measure of physical strain during CPR in a high-altitude alpine environment to provide a better understanding of the physiological changes under these very special conditions.MethodsTwenty experienced mountaineers performed basic life support (BLS) on a manikin for 16 min, both at baseline altitude and at high altitude (3454 m) following a quick and exhausting ascent over 1200 m. Sequence of scenarios was randomised for analysis. Heart rate was continuously measured and compared between baseline and high altitude by absolute differences and robust confidence intervals.ResultsDuring CPR at baseline, the average heart rate increased from 87 bpm (SD 16 bpm) to 104 bpm [increase 17 bpm (95% CI 8.24–24.76)], compared to an increase from 119 bpm (SD 12 bpm) to 124 bpm [increase 5 bpm (95% CI − 1.59 to 12.19)] at high altitude [difference between two groups 32 bpm (95% CI 25–39)]. Differences between periods of chest compressions and ventilations were very similar at baseline [19 bpm (95%CI 16.98–20.27)] and at high altitude [20 bpm 95% CI 18.56–21.44)], despite starting from a much higher level at high altitude. The average heart rates of rescuers at high altitude at any point were higher than those at baseline at any other point.ConclusionPerforming BLS CPR causes exhaustion both at base level and at a high altitude. A further increase during CPR might imply a physiological reserve for adapting to additional physical exertion at high altitude. Phases of ventilation are much needed recovery-periods, but heart rates remain very high. Subjective measures of exhaustion, such as the BORG-scale, might lead to rescuers’ overestimation of their own performance.

Comparison of Traditional Didactic Versus Additional Hands-On Simulation Training in the Performance of Basic Life Support in Veterinary Students-A Prospective, Blinded, Randomized Study.

Cardiopulmonary resuscitation (CPR) is a critical skill for veterinarians, but the most effective training methods and techniques are still unknown. In human medicine, simulation training enhances both knowledge and performance of basic life support CPR. This study evaluated the comparative effectiveness of didactic versus a combination of didactic and simulation training on performance and understanding of basic life support techniques in second-year veterinary medical students.

Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria.

Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria. A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis. Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003). This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.

Sudden Cardiac Arrest in a Dental Patient Awaiting Examination.

Sudden cardiac arrest (SCA) is an uncommon event in dental practice; however, the frequency of dentists encountering SCA and other major medical emergencies is increasing. We report the successful resuscitation of a patient who developed SCA while awaiting examination and treatment at a dental hospital. The emergency response team was called upon, and cardiopulmonary resuscitation/basic life support (CPR/BLS), including chest compression and mask ventilation, was promptly initiated. An automated external defibrillator was used, which indicated that the patient's cardiac rhythm was unsuitable for electrical defibrillation. The patient returned to spontaneous circulation after 3 cycles of CPR and intravenous epinephrine. The knowledge and skill levels of dentists regarding resuscitation under emergency circumstances should be addressed. Emergency response systems must be well established, and CPR/BLS knowledge and training should be updated regularly, including optimal management of both shockable and nonshockable rhythms.

Comparison Between Self-Deliberate Practice and Directed Learning Training Methods for Basic Life Support Knowledge and High-Quality Cardiopulmonary Resuscitation Skill Retention in Second-Year Medical Students 3 and 6 Months After Training.

Cardiopulmonary resuscitation (CPR) requires well-trained medical personnel. Multiple learning methods can be done for CPR skills training. This study aimed to compare self-deliberate practice (SDP) method and directed learning (DL) method to improve basic life support (BLS) knowledge and CPR skill performance in medical students. This is an experimental, single-blind, randomized controlled trial study of 40 medical students from February to July 2019. Forty subjects were randomly assigned into SDP and DL groups through a voluntary sampling method. Both groups attended a 1-day course and then practiced once a month for 3months. The DL group had practice sessions with assigned tutors, while the SDP group had to practice by themselves. Examination of BLS knowledge and CPR performance quality (compression depth, rate, and performance score) was collected before and after course lecture, after a skills training, 3 and 6months after training. Subject characteristics of both groups were comparable. Significant knowledge and skill improvement were found in the DL group and the SDP group when compared to their knowledge and skill before training. There were no significant differences between both groups in BLS knowledge and CPR performance quality in all examination periods. Both SDP and DL teaching methods show significant improvement and excellent retention in BLS knowledge and high-quality CPR performance. These two learning methods are both feasible and bring positive results for students. The online version contains supplementary material available at 10.1007/s40670-023-01746-7.

Left ventricle chest compression improves ETCO2, blood pressure, and cerebral blood velocity in a swine model of cardiac arrest and cardiopulmonary resuscitation

IntroductionDuring cardiopulmonary resuscitation (CPR), high quality chest compressions are critical to organ perfusion, especially the brain. Yet, the optimal location for chest compressions is unclear. It was hypothesized that compared with the standard chest compression (SCC) location, left ventricle chest compressions (LVCCs) would result in greater end-tidal carbon dioxide (ETCO2), blood pressure (BP), and cerebral blood velocity (CBV) during CPR in swine. MethodsFemale Landrace swine (N = 32; 35 ± 2 kg) underwent two mins of untreated asphyxiated cardiac arrest (CA). Thereafter, swine were treated with three 2-min cycles of either SCC or LVCC mechanical basic life support CPR (LUCAS 3). ETCO2 (in-line sampling), BP (arterial catheter line), and CBV (transcranial Doppler) were measured during the pre-CA, untreated-CA, and CPR-treated phases. ResultsETCO2, BP, and CBV were similar between groups at pre- and during untreated-CA (P ≥ 0.188). During CPR, ETCO2 (36 ± 6 versus 24 ± 10 mmHg, P < 0.001), mean arterial BP (MAP; 49 ± 9 versus 37 ± 9 mmHg, P = 0.002), and CBV (11 ± 5 versus 5 ± 2 cm/s, P < 0.001) were significantly greater in the LVCC versus SCC group. Moreover, a greater proportion of animals obtained targets for ETCO2 (ETCO2 ≥ 20 mmHg; 52 % (17/33) versus 100 % (32/32), P < 0.001) and diastolic BP (DBP ≥ 25 mmHg; 82 % (33/40) versus 97 % (48/49), P = 0.020) in the LVCC versus SCC group. ConclusionIndicators of cardiac output, BP, and cerebral perfusion during CPR were greatest in the LVCC group, suggesting the quality of chest compressions during BLS CPR may be improved by performing compressions over the left ventricle compared to the centre of the chest.

Basic Life-Support Learning in Undergraduate Students of Sports Sciences: Efficacy of 150 Minutes of Training and Retention after Eight Months.

Several professional groups, which are not health professionals, are more likely to witness situations requiring basic life support (BLS) due to the nature of their job. The aim of this study was to assess BLS learning after 150 min of training in undergraduate students of sports science and their retention after eight months. Participants trained on BLS (150-min session: 30 theory, 120 practice). After training (T1) and after 8 months (T2), we evaluated their performance of the BLS sequence and two minutes of cardiopulmonary resuscitation (CPR). At T1, the 23 participants presented a mean score of 72.5 ± 21.0% in the quality of the CPRs (compressions: 78.6 ± 25.9%, ventilation: 69.9 ± 30.1%). More than 90% of the participants acted correctly in each step of the BLS sequence. At T2, although the overall quality of the CPR performed did not decrease, significant decreases were observed for: correct hand position (T1: 98.2 ± 8.8, T2: 77.2 ± 39.7%), compression depth (T1: 51.4 ± 7.9, T2: 56.0 ± 5.7 mm), and compression rate. They worsened opening the airway and checking for breathing. In conclusions, participants learned BLS and good-quality CPR after the 150-min training session. At eight months they had good retention of the BLS sequence and CPR skills. Training on airway management and the position of the hands during CPR should be reinforced.

Abstract 296: Quality Analysis of Cardiopulmonary Resuscitation From Two Emergency Medical Service Systems Using a Feedback Device

Background: High quality cardiopulmonary resuscitation (CPR) plays a critical role in the success of out-of-hospital resuscitation from sudden cardiac arrest (SCA). AHA guidelines provide protocol to achieve recommended targets for CPR quality metrics including chest compression fraction (CCF), percentage of chest compressions (CCs) with full chest recoil, CC rate and CC depth. Our objective was to report the CPR quality of two emergency medical services (EMS) agencies with different basic life support (BLS) CPR protocols. Methods: Data from 673 patients, 2015 to 2017, suffering out-of-hospital SCA were obtained from Philips FR3 AEDs. The Philips Q-CPR tool was used for real-time CPR feedback, and CC waveforms were recorded for retrospective CPR analysis using Philips Event Review Pro 5.0 and custom software. The two EMS systems had BLS protocol differences: Site 1(King County, WA, n = 93) applied a compression - ventilation ratio of 30:2, while Site 2 (Mecklenburg County, NC, n = 580) applied 200 compressions in each CPR interval and ventilations were performed during CCs. Analyses were performed comparing CPR metrics between sites and to AHA targets. Results: There were 3,460 minutes of resuscitation data analyzed, representing the initial phase of resuscitation prior to ALS. The proportion of cases with shocks was 21.5% (20 of 93) for site 1 and 16.9% (98 of 580) for site 2 (p = 0.3). Both sites achieved guideline metrics though there were statistical differences (Table 1). Compared to site 1, site 2 was associated with a higher CCF, faster CC rate, but less CC depth on average (p &lt; 0.001). Conclusions: High quality CPR defined by AHA guidelines was achieved with both sites during the early phase of AED resuscitation though some differences were observed. Additional investigation should identify equipment, or rescuer characteristics that are important to consistently achieve high quality CPR and how the combination might be tailored to optimize individual patient outcome.

Effects of head-up vs. supine CPR on cerebral oxygenation and cerebral metabolism – a prospective, randomized porcine study

BackgroundRecent studies have shown that during cardiopulmonary resuscitation (CPR) head-up position (HUP) as compared to standard supine position (SUP) decreases intracranial pressure (ICP) and increases cerebral perfusion pressure (CPP). The impact of this manoeuvre on brain oxygenation and metabolism is not clear. We therefore investigated HUP as compared to SUP during basic life support (BLS) CPR for their effect on brain oxygenation and metabolism. MethodsTwenty pigs were anaesthetized and instrumented. After 8 min of cardiac arrest (CA) pigs were randomized to either HUP or SUP and resuscitated mechanically for 20 min. Mean arterial pressure (MAP), ICP, CPP, cerebral regional oxygen saturation (rSO2) and brain tissue oxygen tension (PbtO2) were measured at baseline, after CA and every 5 min during CPR. Cerebral venous oxygen saturation (ScvO2) was measured at baseline, after CA and after 20 min of CPR. Cerebral microdialysis parameters, e.g. lactate/pyruvate ratio (L/P ratio) were taken at baseline and the end of the experiment. ResultsICP was significantly lower in HUP compared to SUP animals after 5 min (18.0 ± 4.5 vs. 24.1 ± 5.2 mmHg; p = 0.033) and 20 min (12.0 ± 3.4 vs. 17.8 ± 4.3 mmHg; p = 0.023) of CPR. Accordingly, CPP was significantly higher in the HUP group after 5 min (11.2 ± 9.5 vs. 1.0 ± 9.2 mmHg; p = 0.045) and 20 min (3.4 ± 6.4 vs. −3.8 ± 2.8 mmHg; p = 0.023) of CPR. However, no difference was found in rSO2, PbtO2, ScvO2 and L/P ratio between groups after 20 min of CPR. ConclusionIn this animal model of BLS CPR, HUP as compared to SUP did not improve cerebral oxygenation or metabolism.

Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance.

IntroductionSurvival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting.MethodsA descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills.ResultsOverall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training.ConclusionOverall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

The influence of high fidelity simulation on first responders retention of CPR knowledge

IntroductionThe purpose of this study was to identify the impact of high-fidelity simulation on the retention of basic life support cardiopulmonary resuscitation (CPR) knowledge among a group of healthcare providers (HCPs). MethodsA twenty-five question exam was completed by nurses and nurse technicians over a two-year period before and after mandatory CPR training with high-fidelity simulation. ResultsMost HCPs scored near 50% or below the passing score (80%) with a mean range of scores between 28% and 84%. HCPs missed questions on the exam that requested specific details related to technique or human physiology during CPR. ConclusionThe current teaching method for basic life support may be enhanced by using high-fidelity simulation, but this modality alone is not enough to support HCPs retention of CPR knowledge. Additional studies are needed to identify strategies that will help HCPs remember specific and detailed information in the CPR algorithm.

"DIRECT CPR"- Mnemonic to remember 2010 AHA BLS CPR guidelines.

The 2010 American Heart Association Guidelines (AHA) for cardiopulmonary resuscitation (CPR) and emergency cardiac care, published on the 50th anniversary of modern CPR, recommend a change in the Basic Life Support (BLS) sequence of steps from A-B-C to C-A-B.[1] This requires all of us to relearn CPR according to the new recommendations. Memory-aids are known to improve our technical abilities and confidence in providing CPR.[2] We suggest a mnemonic “DIRECT CPR” to remember the sequence of assessments and actions to be taken by BLS provider in accordance with the Adult Chain of Survival of the 2010 AHA guidelines for CPR. The mnemonic is expanded as follows: D - Detection (Collapsed person, all is not well). I - Interrogation (Are you OK? Can you hear me?). R - Respiration (Assess for 5-10 seconds). E - Emergency call (Get AED and Equipment for resuscitation). C - Check Carotid pulsations (5-10 seconds) → If absent, start Chest Compressions. (rate of at least 100/minute, depth of at least 5 cm, and allow complete chest recoil). T - Two Breaths (Each breath over one second). C- Continue Compression and Ventilation in a ratio of 30:2 for five cycles. P - Pulse check after five cycles (two minutes). R - Rotate compressors after five cycles (two minutes). Deliver shock if indicated, as soon as AED is ready. Resume CPR starting with chest compressions. Rhythm analysis after five cycles (two minutes).

Intralipid Infusion Diminishes Return of Spontaneous Circulation After Hypoxic Cardiac Arrest in Rabbits

Infusion of lipid emulsion has been shown to reverse lipophilic drug-induced cardiovascular collapse in laboratory models and humans. The effect of high dose lipid in nondrug-induced cardiac arrest is, however, uncertain. In a rabbit model of asphyxial pulseless electrical activity (PEA) we compared lipid augmented with standard advanced cardiac life support (ACLS) resuscitation. Adult New Zealand White rabbits underwent hypoxic PEA via tracheal clamping. After 2 min of cardiac arrest, basic life support cardiopulmonary resuscitation was commenced and 3 mL/kg 20% Intralipid or 3 mL/kg 0.9% saline solution infused. Adrenaline (100 microg/kg) was administered at 4 and 5 min. Return of spontaneous circulation (ROSC), hemodynamic metrics, and survival to 50 min were recorded. Seven of 11 saline-treated rabbits developed ROSC versus 1 of 12 Intralipid-treated animals; P = 0.009. No significant difference in survival to 50 min was observed (3/11 saline vs 0/12 Intralipid; P = 0.211). In this model of hypoxia-induced PEA, standard ACLS resulted in greater coronary perfusion pressure and increased ROSC compared with ACLS plus lipid infusion. Lipid emulsion may be contraindicated in cardiac arrest complicated by significant hypoxia.

The pharmacological effect of epinephrine administration via laryngeal mask airway in a porcine model of asphyxial cardiac arrest

Background:Earlier studies have shown that the laryngeal mask airway (LMA) is an effective alternative method for the administration of drugs. The pharmacological effect of drug administration via the LMA in...

Impact of different compression–ventilation ratios during basic life support cardiopulmonary resuscitation

The 2005 revised guidelines for cardiopulmonary resuscitation (CPR) suggest a universal compression-to-ventilation (C:V) ratio of 30:2. The effects of this ratio in a realistic CPR scenario have not been investigated completely. After 4 min of untreated ventricular fibrillation (VF), 24 pigs were randomly assigned to 6 min of basic-life support (BLS) CPR with 21% oxygen, and either (1) chest compressions only ("CC" group, n=8), or (2) cycles of 30 compressions followed by two breaths with a self-inflating bag (Fio2 0.21, C:V ratio 30:2; "30:2" group, n=8), or (3) 15 compressions followed by two breaths (C:V ratio 15:2; "15:2" group, n=8), all followed by advanced life support. Arterial PO2 during BLS-CPR was higher in the 15:2 group compared to the 30:2 and CC groups (74+/-3 vs. 59+/-2 and 33+/-4 mmHg, respectively; p<0.05). Both mixed-venous PO2 and SO2 were higher in the 15:2 and 30:2 groups, compared to the CC group ( PO2 : 23+/-2 and 25+/-1 vs. 17+/-1 mmHg; SO2: 21+/-6 and 19+/-3 vs. 8+/-1 %, respectively; p<0.05). Arterial pH decreased in the 30:2 and CC groups compared to the 15:2 group (7.33+/-0.03 and 7.25+/-0.02 vs. 7.51+/-0.04, respectively; p<0.001). 4/8, 2/8, and 0/8 animals in the 15:2, 30:2, and CC groups, respectively, had ROSC at the end of the study period (p=ns). Increasing the chest compression ratio from 15:2 to 30:2 resulted in changes in arterial, but not mixed-venous, blood gases; therefore, the advantages of more chest compressions may outweigh a decrease in gas exchange.

Abstract 19: Effects of Stomach Inflation on Hemodynamic and Pulmonary Function During Cardiopulmonary Resuscitation in Pigs

Background : Stomach inflation during cardiopulmonary resuscitation (CPR) is frequent. The purpose of this study was to evaluate effects of different levels of stomach inflation on hemodynamic and pulmonary function during CPR in a porcine model. Methods: After 4min of ventricular fibrillation, randomization to 0, 5, or 10L of stomach inflation was performed in 21 piglets. Basic life support CPR was then initiated for 3min, followed by a combination of epinephrine (45mcg/kg) and vasopressin (0.4U/kg) and defibrillation 2min later, and a post resuscitation phase of 30min. Kruskal-Wallis test was used for analysis; results are given as median (range). Results : During basic life support CPR, 0, 5, and 10L stomach inflation resulted in comparable coronary perfusion pressure between groups [10 (2–20), 8 (4–35), and 5 (0 –18) mmHg, respectively]. Increasing (0, 5, and 10L) stomach inflation resulted in significantly (P&lt;.05) decreasing static pulmonary compliance [52 (38 –98), 19 (8 –32), and 12 (7–15) mL/cmH 2 O, respectively], and significantly increasing mean airway pressure during mechanical ventilation [14 (12–15), 26 (20 – 66), and 40 (13– 46) cmH 2 O]. Arterial partial pressure of oxygen was significantly higher with 0L when compared with 5 and 10L stomach inflation, but comparable between 5 and 10L stomach inflation [378 (88–440), 58 (47–113), and 54 (43–126) mmHg, respectively]. Similarly, arterial partial pressure of carbon dioxide was significantly lower with 0L when compared with 5 and 10L of stomach inflation [30 (24–36), 41(34 –51), and 56 (45– 68) mmHg, respectively]. Return of spontaneous circulation rates were comparable between groups [5/7 in 0L, 4/7 in 5L, and 3/7 in 10L stomach inflation]. Conclusion : In this CPR model, increasing levels of stomach inflation had adverse effects on pulmonary, but not on hemodynamic function.

Critical Time Window for Intra-Arrest Cooling With Cold Saline Flush in a Dog Model of Cardiopulmonary Resuscitation

Mild hypothermia improves outcome when induced after cardiac arrest in humans. Recent studies in both dogs and mice suggest that induction of mild hypothermia during cardiopulmonary resuscitation (CPR) greatly enhances its efficacy. In this study, we evaluate the time window for the beneficial effect of intra-arrest cooling in the setting of prolonged CPR in a clinically relevant large-animal model. Seventeen dogs had ventricular fibrillation cardiac arrest no flow of 3 minutes, followed by 7 minutes of CPR basic life support and 50 minutes of advanced life support. In the early hypothermia group (n=9), mild hypothermia (34 degrees C) was induced with an intravenous fluid bolus flush and venovenous blood shunt cooling after 10 minutes of ventricular fibrillation. In the delayed hypothermia group (n=8), hypothermia was induced at ventricular fibrillation 20 minutes. After 60 minutes of ventricular fibrillation, restoration of spontaneous circulation was achieved with cardiopulmonary bypass for 4 hours, and intensive care was given for 96 hours. In the early hypothermia group, 7 of 9 dogs survived to 96 hours, 5 with good neurological outcome. In contrast, 7 of 8 dogs in the delayed hypothermia group died within 37 hours with multiple organ failure (P=0.012). Early application of mild hypothermia with cold saline during prolonged CPR enables intact survival. Delay in the induction of mild hypothermia in this setting markedly reduces its efficacy. Our data suggest that if mild hypothermia is used during CPR, it should be applied as early as possible.

Role of Pediatricians in Advocating Life Support Training Courses for Parents and the Public

Available literature suggests a need for both initial cardiopulmonary resuscitation basic life support training and refresher courses for parents and the public as well as health care professionals. The promotion of basic life support training courses that establish a pediatric chain of survival spanning from prevention of cardiac arrest and trauma to rehabilitative and follow-up care for victims of cardiopulmonary arrest is advocated in this policy statement and is the focus of an accompanying technical report. Immediate bystander cardiopulmonary resuscitation for victims of cardiac arrest improves survival for out-of-hospital cardiac arrest. Pediatricians will improve the chance of survival of children and adults who experience cardiac arrest by advocating for cardiopulmonary resuscitation training and participating in basic life support training courses as participants and instructors.