Compression-only Resuscitation Research Articles

Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons

AimWe aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. MethodsThis is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. ResultsIn total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13–1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. ConclusionsIn Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

Characteristics and outcomes of out-of-hospital cardiac arrest patients before and during the COVID-19 pandemic in Thailand

BackgroundOut-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand.MethodsThis single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital’s emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected.ResultsA total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period).ConclusionsDuring the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups.Trial registrationThis trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.

The Impact of Two-Minute Training Sessions on Confidence level for Providing Compression-Only Cardiopulmonary Resuscitation

Teresa Faykus, Faculty Advisor, Nursing, West Liberty University; Taylor Curry, Nursing Student and Austin Raines, Nursing Student, West Liberty University, West Liberty, WV.The Impact of Two-Minute Training Sessions on Confidence Level For Providing Compression- Only Cardiopulmonary Resuscitation Studies have shown that bystander compression-only resuscitation for adult, out-of-hospital cardiac arrest victims improve overall survival rates. Unfortunately, 70% of Americans do not know how to administer resuscitation attempts or are afraid of hurting the victim. Therefore, only 27-41% of sudden cardiac arrest victims receive immediate resuscitation attempts. The research question is: Can simplified performance steps, simplified training, and elimination of mouth-to-mouth contact help bystanders feel more confident in taking the appropriate actions for saving a life? Objectives include training college students, staff, and faculty in chest-compression only resuscitation for an adult sudden cardiac arrest victim; measuring self-reported confidence levels before and after the training by using a Likert scale, and gathering self-reported confidence level factors. Nursing students included staff, faculty, and students to randomly participate. Data was gathered, a two-minute training and a return demonstration was completed, and post confidence levels were recorded. Of the total 134 participants, 85% reported a positive change in confidence levels. Of those, 55% had positive differences in their confidence of 2, 3, or 4 levels. When dissecting the confidence factors, three of the six options stood out as being the most chosen: “I feel that I may hurt someone if I don’t do it correctly”, “I don’t know the steps of CPR”, and “I’m afraid that I would get in trouble or get sued”. By understanding how confident the public is in initiating CPR and what influences these confidence levels, training can be better guided.

Knowledge and Attitude Towards Cardiopulmonary Resuscitation Among Doctors of a Tertiary Care Hospital in Karachi.

ObjectiveCardiac arrest is an emergency, which can be managed effectively by sound knowledge and practice of basic life support (BLS) skills. However, it has been globally reported that the knowledge of doctors regarding cardiopulmonary resuscitation (CPR) and BLS is sub-standard. We conducted this study with the aim to assess the knowledge and attitude of doctors toward CPR in Dr. Ruth K.M. Pfau Civil Hospital, one of the largest tertiary care hospitals, in Pakistan.MethodsWe conducted a cross-sectional study, in Dr. Ruth K.M. Pfau Civil Hospital located in Karachi, Pakistan, using cluster sampling. A total of 285 doctors were interviewed.ResultsA majority of the doctors were unaware of the revised rate and depth of chest compressions (65.6% and 75.8% respectively). While many know the abbreviations of BLS and CPR (96.55% and 95.4%, respectively), 56.5% did not know what automated external defibrillator (AED) stood for. CPR was preferred over chest compression-only resuscitation (CCR) by 91.6% of the doctors. Half of the participants rated their knowledge as average. Most stated that they will not be reluctant to perform CPR in an emergency situation. The majority also agreed that BLS training should be an integral part of the medical curriculum.ConclusionThere is an evident lack of knowledge of CPR among healthcare professionals, particularly regarding the updates made in the 2015 American Heart Association (AHA) guidelines. However, an overall positive attitude was observed.

Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study.

To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Terlipressin/adrenaline is better than adrenaline alone in a porcine model of prolonged ventricular fibrillationA randomized controlled study

Objectives. Vasopressors have been routinely used in cardiopulmonary resuscitation. Recent data show that terlipressin may restore blood pressure in asphyxial and prolonged arrests but its potential role in ventricular fibrillation (VF) remains unknown. The aim of this study was to compare coronary (CorPP) and cerebral (CPP) perfusion pressures achieved by terlipressin/adrenaline versus placebo/adrenaline in VF.Methods. Fourteen domestic pigs were randomly assigned into group A and B. After 5 min of untreated VF, compression-only resuscitation was applied for 10 min, followed by advanced life support. Terlipressin in a single-dose of 30 􀀁g·kg-1 was added to the first dose of adrenaline in group A, while placebo was given in group B. CorPP and CPP were calcula-ted from right atrial, aortic and intracerebral pressures. Data were analyzed using repeated measurements ANOVA and a Fisher´s protected LSD post hoc test.Results. Terlipressin/adrenaline maintained CorPP above 10 mmHg for 17.7 min longer than adrenaline alone (P=0.003) unable to prevent refractory hypotension. CorPP (mean±SD) measured at 35, 45, and 55 min after the onset of VF was 12 ± 4, 11 ± 6, and 10 ± 5 mmHg in the terlipressin group A; and 6 ± 4, 1 ± 5, and -1 ± 5 mmHg in placebo group B (P=0.03, <0.001, and <0.001). CPP measured at the same times was 23 ± 7, 20 ± 7, and 23 ± 7 mmHg in group A; and 13 ± 7, 6 ± 5, and 6 ± 7 mmHg in group B (P=0.01, <0.001, and <0.001).Conclusion. The study showed that a single dose of terlipressin, when added to adrenaline, was effective for achievement of higher vital organ perfusion pressures compared to adrenaline alone.

Layperson resuscitation with and without mouth-to-mouth ventilation in different EMS response time zones

Purpose of the study: To assess a survival of cardiac-arrest patients, who received standard resuscitation (CPR) compared to compression-only resuscitation (CCR) in different response time zones (RTZ).

Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians.

To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR) and defibrillation. We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions. The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED), and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR) to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS) (P < 0.001) and advanced cardiac life support (P = 0.005) or to have ever attended to a patient with cardiac arrest (P = 0.007). Female physicians tended to agree that all clinics should have AEDs (P = 0.005) and support legislation to make AEDs compulsory in clinics (P < 0.001). We also found that a large proportion of physicians who were trained in BCLS (P = 0.006) were willing to perform mouth-to-mouth ventilation. Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.

Abstract 2011: Basic Resuscitation with Chest Compression Only for Patients Who Had Out-Of-Hospital Cardiac Arrest Not Witnessed by Bystanders

BACKGROUND SOS-KANTO study showed that bystander chest compression-only resuscitation was the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest ( Lancet 2007 ; 369 ), but few clinical studies have focused on the efficacy of basic resuscitation with chest compression only for patients with unwitnessed out-of-hospital cardiac arrest. METHODS SOS-KANTO study was conducted in 58 emergency hospitals and emergency medical service units. On arrival at the scene, paramedics assessed the technique of basic resuscitation and asked additional questions. The primary endpoint was favorable neurological outcome 30 days after cardiac arrest. RESULTS Of the 9,592 patients with out-of-hospital cardiac arrest, 4,347 adult patients with unwitnessed arrest were included; 385 (8.9%) received chest compression-only resuscitation, 507 (11.7%) received chest compression plus mouth-to-mouth ventilation resuscitation, and 3,456 (79.5%) received no resuscitation. Any resuscitation attempt was associated with a higher proportion of the favorable neurological outcome than no resuscitation (1.1% vs. 0.4%, p=0.009). The chest compression-only resuscitation group had higher proportions of the favorable neurological outcome than the no resuscitation group in the whole cohort (1.3% vs. 0.4%, p=0.018) and in the subgroups of patients with cardiac causes (2.0% vs. 0.6%, p=0.018) and with time interval from EMS call to arrival at patient’s side for ≤ 8 min (2.0% vs. 0.6%, p=0.020). However, the chest compression-only resuscitation group had a similar proportion of the favorable neurological outcome than the chest compression plus ventilation resuscitation in the whole cohort (1.3% vs. 1.0%, p=0.662) and there was no evidence for any benefit from the addition of ventilation in any subgroups. The adjusted odds ratios for the favorable neurological outcome after chest compression-only resuscitation and after chest compression plus ventilation resuscitation were 3.4 (95% CI, 1.1 to 10.5, p=0.033) and 3.3 (95% CI, 1.1 to 10.1 p=0.035). CONCLUSIONS Basic resuscitation with chest compression only is the preferable approach to resuscitation even though the adult patients with unwitnessed out-of-hospital cardiac arrest.