Interruptions In Chest Compressions Research Articles

Effectiveness of team-focused CPR on in-hospital CPR quality and outcomes

ObjectiveWe sought to identify changes in neurological outcome over time following initial training and subsequent implementation of team-focused CPR in an inpatient setting where responders practice specific roles with emphasis on minimally interrupted chest compressions and early defibrillation. MethodsThis retrospective pre- vs post-intervention study was conducted at an urban 900-bed teaching hospital and Level I Cardiac Resuscitation Center. We included adult patients suffering in-hospital cardiac arrest occurring in non-emergency department and non-intensive care unit areas who received CPR and/or defibrillation. We compared survival with good neurological outcome at time of hospital discharge in the one-year periods before and after implementation of team-focused CPR. To investigate skill degradation, we compared cumulative survival with good neurological outcome in 3-month intervals against the before team-focused CPR baseline. Trained research associates abstracted explicitly defined variables from electronic health records using a standardized form and data dictionary to achieve consistency between collaborators. ResultsOf 296 IHCAs, 207 patients met inclusion criteria and were analyzed. In 104 patients before team-focused CPR initiation, survival with good neurological outcome was 21%. In the 12-month period following team-focused CPR initiation, survival with good neurological outcome was 31% in 101 patients, risk difference 9.9% (95% CI −2 to 22%; p = 0.14). By quarterly time intervals, following team-focused CPR implementation, the cumulative survival with good neurological outcome at 3 months was 42%; at 6 months 37%; at 9 months 31%; and at 12 months 31%. ConclusionIn our single-institution implementation of team-focused CPR for in-hospital cardiac arrest, outcomes significantly improved at 6 months before declining towards baseline.

Resuscitation Update - What's New?

Perfect, uninterrupted basic life support (BLS) is the key for successful cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). Time plays an important role in the treatment of OHCA. This applies both to the time until the start of BLS and the reduction of all pauses during resuscitation, especially chest compressions. In 2022, the rate of bystander-CPR showed an absolute increase of 4% compared to previous years. The bystander-CPR rate is currently above 50%. Compared to OHCA in adults, cardiac arrest in children is rare in Germany. In the period from 2007 to 2021, the incidence was 3.08 per 100000 children. In addition, the etiology in children varies depending on the age group. While hypoxia is often the cause of circulatory arrest in younger children, trauma and drowning accidents are the main causes in school-age children. Different additional diagnostic and therapeutic strategies have been evaluated over the last years. Point-of-care ultrasound during resuscitation should only be performed by experienced users. Interrupting chest compressions and thus prolonging the no-flow phases must be avoided. Double sequential external defibrillation after the third shock can successfully terminate refractory ventricular fibrillation. While further studies are needed, emergency medical systems should train their teams to avoid complications. In refractory OHCA, extracorporeal CPR should be considered. In the case of in-hospital cannulation, immediate transport should be weighed against impaired chest compression quality. Therefore, transportation under CPR is only beneficial if there is an indication for further treatment.

Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review.

Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation.

To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust se s for adjusted analyses. Quaternary care children's hospital. Pediatric patients undergoing ECPR. None. Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86-0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93-0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability ( sd > 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher. Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.

Performances and limits of Bag-Valve-Device for pre-oxygenation and manual ventilation: A comparative bench and cadaver study

IntroductionBag-Valve-Device (BVD) is the most frequently used device for pre-oxygenation and ventilation during cardiopulmonary resuscitation (CPR). A minimal expired fraction of oxygen (FeO2) above 0.85 is recommended during pre-oxygenation while insufflated volume (VTi) should be reduced during manual ventilation. The objective was to compare the performances of different BVD in simulated conditions. MethodsNine BVD were evaluated during pre-oxygenation: spontaneous breathing patients were simulated on a test lung (mild and severe conditions). FeO2 was measured with and without positive end-expiratory pressure (PEEP). CO2 rebreathing was evaluated. Then, manual ventilation was performed by 36 caregivers (n = 36) from three hospitals on a specific manikin; same procedure was repeated by 3 caregivers (n = 3) on two human cadavers with three of the nine BVD: In non-CPR scenario and during mechanical CPR with Interrupted Chest Compressions strategy (30:2). ResultsPre-oxygenation: FeO2 was lower than 0.85 for three BVD in severe condition and for two BVD in mild condition. FeO2 was higher than 0.85 in eight of nine BVD with an additional PEEP valve (PEEP 5 cmH2O). One BVD induced CO2 rebreathing.Manual ventilation: For non-CPR manual ventilation, mean VTi was within the predefined lung protective range (4–8 mL/kg PBW) for all BVD on the bench. For CPR manual ventilation, mean VTi was above the range for three BVD on the bench. Similar results were observed on cadavers. ConclusionsSeveral BVD did not reach the FeO2 required during pre-oxygenation. Manual ventilation was significantly less protective in three BVD. These observations are related to the different BVD working principles.

Traumatic cardiac arrest.

This review considers the latest evidence relating to the epidemiology and outcomes, treatment guidelines, diagnostic and therapeutic interventions in traumatic cardiac arrest. There is variation in the incidence and outcomes of traumatic cardiac arrest which is influenced in part by case definitions. Irrespective of case definitions outcomes from traumatic cardiac arrest are typically worse than those seen from cardiac arrest due to medical causes but not so poor as to consider that treatment is futile. Clinical guidelines focus on the prompt treatment of reversible causes, although evidence that this improves outcomes is limited. Point of care ultrasound to assist with the identification of reversible causes should be limited to experienced operators where there is thought to be a high likelihood of a reversible cause being present. Care should be taken to minimize interruptions in chest compressions during scanning. There is little recent evidence to support specific therapeutic interventions. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta during traumatic cardiac arrest remains to be determined in on-going research. Trauma related cardiac arrest differs from cardiac arrest due to medical causes. Whilst the core principles of treatment are similar, a higher priority is placed on identifying and treating reversible causes.

Airway management during ongoing chest compressions-direct vs. video laryngoscopy. A randomised manikin study.

Tracheal intubation is used for advanced airway management during cardiac arrest, particularly when basic airway techniques cannot ensure adequate ventilation. However, minimizing interruptions of chest compressions is of high priority. Video laryngoscopy has been shown to improve the first-pass success rate for tracheal intubation in emergency airway management. We aimed to compare first-pass success rate and time to successful intubation during uninterrupted chest compression using video laryngoscopy and direct laryngoscopy. A total of 28 anaesthetists and 28 anaesthesia nurses with varied clinical and anaesthesiological experience were recruited for the study. All participants performed a tracheal intubation on a manikin simulator during ongoing chest compressions by a mechanical resuscitation device. Stratified randomisation (physicians/nurses) was performed, with one group using direct laryngoscopy and the other using video laryngoscopy. First-pass success rate was 100% (95% CI: 87.9% - 100.0%) in the video laryngoscopy group and 67.8% (95% CI: 49.3% - 82.1%) in the direct laryngoscopy group [difference: 32.2% (95% CI: 17.8% - 50.8%), p<0.001]. The median time for intubation was 27.5 seconds (IQR: 21.8-31.0 seconds) in the video laryngoscopy group and 30.0 seconds (IQR: 26.5-36.5 seconds) in the direct laryngoscopy group (p = 0.019). This manikin study on tracheal intubation during ongoing chest compressions demonstrates that video laryngoscopy had a higher first-pass success rate and shorter time to successful intubation compared to direct laryngoscopy. Experience in airway management and professional group were not significant predictors. A clinical randomized controlled trial appears worthwhile.

Direct versus Video Laryngoscopy during Simulated Mechanical Chest Compressions: A Randomized Crossover Trial.

Sir, Mechanical compression devices are often utilized for cardiopulmonary resuscitation (mCPR) in the emergency department (ED). We conducted an investigation to evaluate the time to intubation, operator confidence, and success rates of endotracheal intubation with video laryngoscopy (VL) versus direct laryngoscopy (DL) during simulated mCPR. This was a prospective, randomized crossover trial. Thirty consenting emergency physicians were surveyed about experience/technique preferences, and then performed intubations on a moderately difficult airway and adult Manikin during simulated mCPR (LUCAS 3.0) at 100 compressions/min. Technique order was randomized. Intubation time defined as blade pick up until the tube cuff inflated. Participants rated success confidence on a 5-point scale (high = 5) and provided the Cormack/Lehane grade (difficult = 3 or 4). The scenario was repeated with the alternate technique. The categorical variables analyzed by the Chi-square and continuous variables by t-tests. Multivariate logistic regression was performed to control for confounding. There were 30 participants: 73% with 1–5 years of experience, 40% with >100 prior intubations, 73% utilized mac 4 direct blade, and 60% prefer VL during cardiopulmonary resuscitation (CPR). Participants had first pass intubation success for all but one of the attempts with both modalities (NS). Participants more often expressed “high confidence” that intubation was successful for direct 60% versus video 77% (P = 0.2), but they more often rated the airway “difficult” for direct (40% vs. 10%; P = 0.01). Within bivariate analysis, mean time difference to intubate was less for DL versus VL (−6.8 s; P = 0.02). There were no significant associations between time differences to intubate for the following variables: experience (P = 0.6), >100 prior intubations (P = 0.8), blade size (P = 0.3), preferred technique (P = 0.8), high confidence successful DL (P = 0.5), high confidence successful VL (P = 0.7), rating of difficult view DL (P = 0.8), and rating of difficult view VL (P = 0.9). In the multivariate logistic regression with time difference as the dependent variable, there were no statistically significant independent variables. Several prior investigators have reported the success rates of endotracheal intubation with and without chest compressions.[1–5] Han etal. described that VL was superior to DL in simulated CPR settings and that interruption of chest compressions was seemingly unnecessary.[1,3] However, within our literature search, we did not find earlier studies comparing VL versus DL mCPR. In contrast to the findings of Han etal., we observed a lower mean time difference to intubation for DL versus VL during simulated mCPR in our current study, although such differences are unlikely clinically meaningful. On the other hand, participants in our study group were more confident that intubation was successful when using VL. The limitations of our study include single center site, small sample size, participants had varying prior intubation experience, and the high-fidelity Manikin may not replicate all the aspects of difficult intubation in the setting of actual CPR in the ED. Future studies evaluating DL versus VL during mCPR should be conducted in the clinical setting. Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract 163: Lung Inflation Occurs Infrequently In Most Patients During 30:2 CPR With Bag-Valve-Mask Ventilation

Background: Few studies have measured ventilation early in cardiopulmonary resuscitation (CPR) before advanced airway placement. In 30:2 CPR, there is a pause to give two ventilations after each round of 30 chest compressions. Recently, we developed a method to identify lung inflation (ventilation) waveforms from thoracic bioimpedance defibrillator recordings measured through defibrillator pads. Early work showed that in 75% of patients receiving bag-valve-mask (BVM) ventilation, lung inflation waveforms occurred in less than half of pauses in chest compressions during 30:2 CPR. Objective: To determine the incidence of lung inflation with BVM during 30:2 CPR in a multi-center study. Methods: Our study included adult out-of-hospital cardiac arrest patients from five sites of the Resuscitation Outcomes Consortium Trial of Continuous or Interrupted Chest Compressions during CPR. Patients had 30:2 CPR with ≥ two minutes of thoracic bioimpedance signal recorded with a defibrillator (Lifepak, Physio-control, Redmond, WA or MRx, Philips, Andover, MA). Previously, we defined a ventilation waveform as having a bioimpedance amplitude ≥0.5 Ohm (corresponding to ≥ 250 ml Vt) with a duration ≥1 sec. A valid pause was 3 sec to 15 sec. An automated program analyzed the recordings. We describe groups with ventilation waveforms in &lt;50% or ≥50% of pauses. Results: We included 1,552 patients; mean age was 66 years, 67% were male, mean (±SD) duration of 30:2 CPR was 9.9 ±5.8 min from the start of chest compressions until advanced airway placement. During this period there was a total of 21,705 pauses in chest compressions, a median of 12 pauses in chest compressions, and a median of 5 ventilations; 56% of patients had ventilation waveforms in &lt;50% of pauses (Group 1, N=868), and 44% had waveforms in &gt; 50% of pauses (Group 2, N=678). The median (IQR) number of pauses in Group 1 vs. Group 2, was 12 (8, 20) vs. 12 (7, 17) and the median number of ventilations was 3 (1, 6) vs. 13 (7, 21), respectively, during 30:2 CPR. The median duration of pauses for Group 1 vs. Group 2, was 5.8s (5.0, 6.5) vs. 5.7s (5.0, 6.7). Conclusion: For most patients, this multi-center study showed that ventilation waveforms were present in less than 50% of pauses in chest compressions during 30:2 CPR with BVM ventilation.

Abstract 199: Femoral Artery Doppler Ultrasound Blood Flow Patterns Predict Intrinsic Pulsatility In Cardiac Arrest Patients Receiving Active Chest Compressions

Introduction: Pulse detection requires chest compression interruption, which is associated with poor outcomes in cardiac arrest. Currently no modality can reliably identify return of spontaneous circulation with ongoing chest compressions. Hypothesis We hypothesized that patients with intrinsic pulsatility have anterograde dominant blood flow (ADF) on arterial Doppler ultrasound; whereas those with intrinsic pulselessness have bidirectional blood flow moving antero/retrograde during chest compression/decompression. Methods: We conducted a prospective, diagnostic accuracy study on a convenience sample of adult Emergency Department (ED) cardiac arrest patients with a femoral arterial line in place. Immediately prior to a pulse check, pulsed-wave Doppler ultrasound of the common femoral artery was performed during active chest compressions. Bidirectional flow was present when the anterograde flow waveform was equal in peak systolic velocity to the retrograde flow waveform. All other Doppler waveforms were ADF. A pulse was present when there was an arterial line waveform. Sensitivity, specificity, and accuracy of ADF versus bidirectional flow for predicting pulsatility was assessed. Results: We enrolled 42 patients and performed 104 pulse checks: a pulse was present for 73 (70.2%) and absent in 31 (29.8%). ADF was present in 82 (78.9%) and bidirectional flow was present in 22 (21.2%). Sensitivity of ADF for detecting a pulse was 95.9% (95% CI: 91.3%-100.0%). Specificity of bidirectional flow for detecting pulselessness was 61.3% (95% CI: 44.1-78.4%) and accuracy was 85.6% (95% CI: 77.3-91.7%). Patients with ADF have 36.9 times the odds of having an arterial line pulse compared with patients with bidirectional flow (OR: 36.9; 95% CI: 9.5-144.4). Conclusion: In ED cardiac arrest patients, ADF on Doppler ultrasound has high sensitivity for detecting an arterial line pulse. Further studies are needed to further evaluate this novel finding.

Tracheal Intubation during Advanced Life Support Using Direct Laryngoscopy versus Glidescope® Videolaryngoscopy by Clinicians with Limited Intubation Experience: A Systematic Review and Meta-Analysis.

The use of the Glidescope® videolaryngoscope might improve tracheal intubation performance in clinicians with limited intubation experience, especially during cardiopulmonary resuscitation (CPR). The objective of this systematic review and meta-analysis is to compare direct laryngoscopy to Glidescope® videolaryngoscopy by these clinicians. PubMed/Medline and Embase were searched from their inception to 7 July 2020 for randomized controlled trials, including simulation studies. Studies on adult patients or adult-sized manikins were included when direct laryngoscopy was compared to Glidescope® videolaryngoscopy by clinicians with limited experience in tracheal intubation (&lt;10 intubations per year). The primary outcome was the intubation first-pass success rate. Secondary outcomes were time to successful intubation and chest compression interruption duration during intubation. The risk of bias was assessed with the Cochrane risk of bias tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). We included 4 clinical trials with 525 patients and 20 manikin trials with 2547 intubations. Meta-analyses favored Glidescope® videolaryngoscopy over direct laryngoscopy regarding first-pass success (clinical trials: risk ratio [RR] = 1.61; 95% confidence interval [CI]: 1.16-2.23; manikin trials: RR = 1.17; 95% CI: 1.09-1.25). Clinical trials showed a shorter time to achieve successful intubation when using the Glidescope® (mean difference = 17.04 s; 95% CI: 8.51-25.57 s). Chest compression interruption duration was decreased when using the Glidescope® videolaryngoscope. The certainty of evidence ranged from very low to moderate. When clinicians with limited intubation experience have to perform tracheal intubation during advanced life support, the use of the Glidescope® videolaryngoscope improves intubation and CPR performance compared to direct laryngoscopy.

Manual vs. mechanical ventilation in patients with advanced airway during CPR

Early chest compressions and rapid defibrillation are important components of cardiopulmonary resuscitation (CPR). American heart association (AHA) recommends two breaths to be delivered for every 30 compressions for an adult cardiac arrest victim. Patient with an advanced airway like endotracheal tube (ETT) should be given one breath every 6 s without interruptions in chest compression (10 breaths per minute). All of the modern mechanical ventilators have option to generate spontaneous breaths by the patient if the patient has spontaneous respiratory efforts. During CPR, the mechanical ventilator is fallaciously sensing the chest compressions as patient's spontaneous trigger and thereby it delivers higher respiratory rates. Avoiding excessive ventilation is one of the components of high quality CPR as excessive ventilation decreases venous return thereby decreasing the cardiac output and also it affects intra-thoracic pressure thereby adversely affects intra-arterial pressure. As modern ventilators have trigger for spontaneous breaths and they will be erroneously triggered by chest compressions, it would be prudent to use volume marked resuscitation bags or manual breathing devices (manual self-inflating resuscitation bag, Bain's circuit) for delivering breaths which can be synchronised with compression phase of CPR at RR of 10 breaths per min with advanced airway in place. If any patient who is on mechanical ventilation develops cardiac arrest, patient should be disconnected from the mechanical ventilator and should be ventilated manually. Manual ventilation with aforementioned breathing devices should be used in a patient without and with advanced airway devices during CPR.

Back Plate Marking of a Mechanical Chest Compression Device to Reduce the Duration of Chest Compression Interruptions.

ObjectiveTo compare the effectiveness of applying the back plate marking method vs the standard method, to a mechanical chest compression device, in regards to reducing the duration of chest compression interruptions during a simulated cardiac arrest.MethodsAn experimental study, one group pretest posttest design, conducted in a university-based hospital from November 2020 to October 2021. The study recruited 20 participants including emergency medical residents and paramedics. The participants were randomized into three-person teams and applied the device in both standard and back plate marking methods in sequential order. Teams were required to use a mechanical chest compression device in a manikin-based OHCA simulation to assess performance.ResultsThe median time pause for the deployment of the upper part of the device was significantly reduced (16 vs 21s, P < 0.01) in the back plate marking method, as was the total pause for device deployment (31.5 vs 38.75s, P = 0.03) and the proportion of total hands-off time attributable to device application interruption (43.08% vs 49.18%, P = 0.02). There was no difference between groups in the duration of all compression interruptions (70.5 vs 82.75s, P = 0.20) and compression fractions (77.85 vs 76.91%, P = 0.19).ConclusionThe back plate marking method was a significantly reduced time of the deployment of the upper part of the device and in regards to the overall pause for device deployment, but there was no difference in CPR quality between the two methods.

Effect of Coaching with Repetitive Verbal Encouragements on Dispatch-Assisted Cardiopulmonary Resuscitation: A Randomized Simulation Study

BackgroundCurrent guidelines emphasize the assistance of the emergency dispatcher in bystander cardiopulmonary resusitation (CPR). Its quality, however, has varied across cases. ObjectiveTo determine the effect of repetitive coaching by dispatchers using verbal encouragement on the quality of lay-rescuer CPR. MethodsWe conducted a dispatch-assisted CPR (DACPR) simulation study. Participants with no CPR training within the previous year were assigned randomly to 1 of 2 DACPR simulations. One was the No Coaching Group: callers were told to perform CPR and the dispatcher periodically confirmed that the caller was performing CPR. The second group was the Coaching Group: the dispatcher repetitively coached, encouraged, and counted aloud using a metronome. Participants performed CPR for 2 min under instruction from the study dispatcher. Parameters including chest compression depth, rate, and chest compression fraction were recorded by video camera and CPR manikin. ResultsForty-nine participants 20 to 50 years of age were recruited, and 48 completed the simulation (Coaching Group, n = 27; No Coaching Group, n = 21). The chest compression fraction was higher in the Coaching Group (99.4% vs. 93.0%, p = 0.005) and no participants interrupted chest compression more than 10 s in this group. When comparing the average depth of each 30-s period in each group, the depth increased over time in the Coaching Group (40.9 mm, 43.9 mm, 44.1 mm, and 42.8 mm), while it slightly decreased in the No Coaching Group (40.6 mm, 40.1 mm, 39.4 mm, and 39.8 mm). ConclusionsRepetitive verbal encouragements augmented chest compression depth with less-hands off time. Continuous coaching by dispatchers can optimize lay-rescuer CPR. © 2022 Elsevier Inc.

Effect of peer videorecording feedback CPR training on students’ practical CPR skills: a randomized controlled manikin study

BackgroundThe aim of this study was to compare one-month acquisition and half-a-year quality retention of cardiopulmonary resuscitation (CPR) skills after initial training of medical students between peer videorecording feedback training (PVF) and traditional peer verbal feedback training (TVF).MethodsParticipants were randomly assigned to the PVF group (n = 62) and the TVF group (n = 65). All participants received a 45-min CPR training program performed by an American Heart Association basic life support-certified instructor, and then they began two hours of practice in groups. During interactive peer learning, students cooperated in couples of a doer and a helper to realize maximization of each other’s learning. In the PVF group, training performance feedback came from peers based on practice videorecording. In the TVF group, feedback came from peers verbally without videorecording. CPR quality was tested at 1 and 6 months after training.ResultsAfter 1 month of initial training, the PVF group had a better presentation of CPR skills acquisition than the TVF group. Compared to the TVF group, the PVF group had significantly higher total scores, compression depth, appropriate compression depth, and complete chest recoil (p < 0.05). Moreover, compression interruption was a significantly positive change in the PVF group compared to the TVF group (p < 0.05). However, after 6 months, proportions of appropriate compression depth in the PVF group were better than those in the TVF group (p < 0.05). The differences in total scores, compression depth, appropriate compression depth, complete chest recoil and compression interruption were non-significant (all p > 0.05).ConclusionsCompared to TVF, PVF is more effective in enhancing CPR skill acquisition at 1 month. After half a year, CPR skill quality was obviously reduced in both groups, and no difference in CPR quality was found between the two groups.

Pediatric Advanced Life Support in a Neonatal Context.

Pediatric Advanced Life Support in a Neonatal Context.

Compression Device-Assisted Extracorporeal Cardiopulmonary Resuscitation Cannulation in Pediatric Patients-A Simulation Study.

Background: Surgical neck cannulation for pediatric extracorporeal cardiopulmonary resuscitation (ECPR) requires multiple interruptions of manual chest compressions to facilitate the procedure. Effective uninterrupted CPR is essential to prevent neurological injury. We hypothesized that an automated chest compression device can be used to provide effective and uninterrupted chest compressions during pediatric neck ECPR cannulation. The feasibility of surgically cannulating the right carotid artery and right internal jugular vein in an infant during ongoing automated chest compressions was tested in a simulation study. Methods: A working prototype of a pediatric chest compression device was designed to provide automated chest compressions on an infant CPR manikin at the rate of 120 compressions/minute. A feedback device attached to the manikin was used to monitor the effectiveness of CPR. A synthetic artery, vein along with carotid sheath and skin was utilized to simulate surgical neck exploration. ECPR simulation was conducted using the compression device to provide chest compressions. Results: Four ECPR simulations were conducted during which vessel sparing (n = 2) and non-vessel sparing (n = 2) cannulation of the right internal carotid artery and right internal jugular vein were performed during ongoing mechanical chest compressions. All four cannulations were successfully performed without the need to interrupt chest compressions. Conclusions: In a simulated environment, pediatric ECPR neck cannulation with uninterrupted chest compressions may be accomplished using an automated chest compression device. The strategy of compression device-assisted ECPR cannulation requires further study and could potentially reduce the neurological complications of ECPR.

Novel Mode of Near-Infrared Spectroscopy as a Continuous Cerebral Physiological Monitoring Device during Cardiopulmonary Resuscitation: Four Case Reports.

Background: NIRO-Pulse is a novel mode of near-infrared spectroscopy that can be used to visually evaluate cerebral perfusion during cardiopulmonary resuscitation (CPR), providing real-time feedback as to the quality of the CPR. The aim of this report was to describe the several representative cases of NIRO-Pulse for physiological monitoring during CPR. Methods: We present several cases from out-of-hospital cardiac arrest (OHCA) patients for whom NIRO-Pulse was attached to the forehead after hospital arrival. Patients were subjected to continuous brain monitoring during CPR using NIRO-Pulse, which allows for the visualisation of ΔHb (Hb pulsation). NIRO-Pulse is capable of simultaneously measuring and displaying cerebral tissue oxygen saturation (SctO2) and Hb pulsation, providing real-time feedback during CPR in the form of physiological indicators, and assessing changes in SctO2 throughout the CPR procedure by post-mortem analysis. Results: We observed several representative cases that provided the following insights: (1) SctO2 increased after a change in the quality of chest compression, (2) SctO2 decreased during the ventilation phase of synchronised CPR, (3) SctO2 decreased during the interruption of chest compressions for the preparation of defibrillation, and (4) SctO2 gradually and continuously increased after return of spontaneous circulation. Conclusion: Displaying Hb pulsation in conjunction with SctO2 during CPR may be helpful for evaluating the quality of and patient responsiveness to CPR. Further studies investigating the association between the use of NIRO-Pulse during CPR and subsequent outcomes should be conducted.

Effect of sodium bicarbonate on functional outcome in patients with out-of-hospital cardiac arrest: a post-hoc analysis of a French and North-American dataset.

No large randomised controlled trial has assessed the potential benefits on neurologic outcomes of prehospital sodium bicarbonate administration in patients with nontraumatic out-of-hospital cardiac arrest (OHCA). To obtain information of assistance in designing a randomised controlled trial of bicarbonate therapy after OHCA in specific patient subgroups. We conducted two, separate, simultaneous, retrospective studies of two distinct, unlinked datasets. One dataset was a French nationwide population-based registry (RéAC Registry, French dataset) and the other was a randomised controlled trial comparing continuous to interrupted chest compressions in North America (ROC-CCC trial, North-American dataset). We investigated whether prehospital bicarbonate administration was associated with better neurologic outcomes. The main outcome measure was the functional outcome at hospital discharge. To adjust for potential confounders, we conducted a nested propensity-score-matched analysis with inverse probability-of-treatment weighting. In the French dataset, of the 54 807 patients, 1234 (2.2%) received sodium bicarbonate and 450 were matched. After propensity-score matching, sodium bicarbonate was not associated with a higher likelihood of favourable functional outcomes on day 30 [adjusted odds ratio (aOR), 0.912; 95% confidence interval (95%CI), 0.501-1.655]. In the North-American dataset, of the 23 711 included patients, 4902 (20.6%) received sodium bicarbonate and 1238 were matched. After propensity-score matching, sodium bicarbonate was associated with a lower likelihood of favourable functional outcomes at hospital discharge (aOR, 0.45; 95% CI, 0.34-0.58). In patients with OHCA, prehospital sodium bicarbonate administration was not associated with neurologic outcomes in a French dataset and was associated with worse neurologic outcomes in a North-American dataset. Given the considerable variability in sodium bicarbonate use by different prehospital care systems and the potential resuscitation-time bias in the present study, a large randomised clinical trial targeting specific patient subgroups may be needed to determine whether sodium bicarbonate has a role in the prehospital management of prolonged OHCA.

Airway Management During Cardiopulmonary Resuscitation.

Purpose of the reviewThis review summarizes the updated literature on airway management during cardiopulmonary resuscitation (CPR). It provides guidance for clinicians to carefully incorporate the most recent recommendations related to airway management, oxygenation, and ventilation both during CPR and after return of spontaneous circulation.Recent FindingsThe American Heart Association and the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care provide updated recommendations related to airway management during CPR, which focus on advanced airway strategies in out-of-the hospital cardiac arrest and in-hospital cardiac arrest. There is no evidence that any single advanced airway technique is superior to the other in terms of survival and neurological outcomes. There is controversy as to whether early advanced airway management could lead to favorable outcome.SummaryAdvanced airway strategies and alternatives to airway management (including passive oxygenation) can be utilized in different settings while minimizing interruption in chest compressions.