CPR Performance Research Articles

Vasopressor or advanced airway first in cardiac arrest?

BackgroundWhile resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). MethodsWe analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders. ResultsOf 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6–11) and ALS arrival-to-airway 11 min (8–15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71–1.31), ROSC (0.83; 0.66–1.06), hospital survival (1.09; 0.68–1.73), or hospital survival with favorable neurologic status (0.97; 0.53–1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters. ConclusionsVasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.

Systematic review and meta-analysis of the diagnostic accuracy of inflammatory markers for infected diabetic foot ulcer

The aim was to evaluate the diagnostic value of ESR, CPR, PCT, and WBC in patients with infected diabetic foot ulcer (DFU). The MEDLINE, Embase, BIOSIS, Cochrane databases, and Web of Knowledge databases were searched, without language restriction, to July 2023. Original studies were selected that reported the performance of ESR, CPR, PCT, and WBC in diagnosing infected DFU. To assess the diagnostic value of biomarkers for infected DFU, pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (ROC-AUC) were calculated. Ten studies with 765 patients were identified in our meta-analysis. The pooled sensitivity and specificity of ESR was 0.82 (95% CI: 0.68-0.91) and 0.83 (95% CI: 0.69-0.91) respectively. The pooled sensitivity and specificity of CRP was 0.81 (95% CI: 0.65-0.91) and 0.91 (95% CI: 0.79-0.96) respectively. The pooled sensitivity and specificity of PCT was 0.76 (95% CI: 0.65-0.85) and 0.89 (95% CI: 0.78-0.95) respectively. The pooled sensitivity and specificity of WBC was 0.75 (95% CI: 0.64-0.83) and 0.79 (95% CI: 0.67-0.88) respectively. CRP showed the best diagnostic accuracy at distinguishing infected DFU from noninfected DFU with an AUC of 0.93, followed by PCT (AUC of 0.89), ESR (AUC of 0.89), and WBC (AUC of 0.84). CPR levels had high efficiency in distinguishing infected DFU from noninfected DFU, followed by PCT, ESR and WBC. All of these biomarkers could be helpful for early diagnosis of infected DFU. New biomarkers for improving medical decision in diagnosis of infected DFU are highly desirable.

Examining the impact of dispatch-assisted CPR on bystander CPR performing

Background: Dispatcher-assisted CPR involves emergency medical dispatchers (EMD) delivering real-time CPR instructions to callers during emergencies. This method aims to enable timely bystander CPR before the arrival of emergency medical services, improving survival rates and neurological outcomes of out-of-hospital cardiac arrest (OHCA). This study evaluates the effectiveness of telephone-guided CPR instructions using retrospective audio data. Methods: A retrospective study analyzed OHCA incidents in Mahasarakham, Songkhla, and Prachinburi within a metropolitan EMS system. Audiotapes from emergency calls between January and December 2021 were reviewed. Included were OHCA patients who called the dispatch center and were transported to the hospital by EMS. Exclusions included cardiac arrests in nursing homes, doctors' offices, and jails, as well as cases where EMS witnessed the OHCA or callers initiated CPR before receiving instructions. Results: The study analyzed 280 patients, with 146 callers (52.1%) agreeing to perform CPR. Among the provided DA-CPR instructions, 18 items were significantly associated with bystander CPR performance. Five items that could be omitted to reduce OHCA recognition time delay include the introduction, requesting contact numbers, inquiring about the number of patients, assessing scene safety, and advising tilting the patient in case of vomiting. Conclusions: To reduce the delay in identifying cardiac arrest and promptly initiating chest compressions during OHCA, it is suggested to employ a video call system for early detection of abnormal breathing and unconsciousness. Additionally, integrating automatic geolocation can expedite EMS response.

Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Abstract 308: Comparison of Cardiopulmonary Resuscitation Performance Between Integrated CPR Device Performing Chest Compression and External Defibrillation versus LUCAS3 With Automated External Defibrillator: A Animal and Manikin-Based Pilot Study

Background: Early chest compression and defibrillation are important components for successful resuscitation. The use of mechanical CPR has increased after the outbreak of COVID-19, and this trend continued in the post-pandemic period. We developed an automatic CPR performing chest compression and external defibrillation simultaneously following current CPR algorithm. Methods: This study was designed as a study to compare the performance of CPR and AED between automatic CPR apparatus (A-CPR) and commercially proven mechanical CPR device (LUCAS3) plus AED (C-CPR) during CPR in swine cardiac arrest model and the study to evaluate feasibility of A-CPR in simulated cardiac arrest model. Results: There were no significant differences in hemodynamic variables between the groups. Time to ECG analysis [38.0 sec in A-CPR, 48.0 sec in C-CPR, p =0.010], time to initial shock advice plus subsequent chest compression [46.0 sec in A-CPR, 57.0 sec in C-CPR, p =0.017], time to first defibrillation [48.5 sec in A-CPR, 65.0 sec in C-CPR, p =0.004], charge to shock interval [3.0 sec in A-CPR, 8.0 sec in C-CPR, p =0.001], and hands-off time [11.0 sec in A-CPR, 22.5 sec in C-CPR, p =0.001] were significantly shorter in A-CPR group than C-CPR group. In the simulation study, the pure chest compression time [101 sec in A-CPR, 110 sec in C-CPR, p&lt; 0.001], hands-off time [75 sec in A-CPR, 94 sec in C-CPR, p&lt; 0.001], time from power-on to first chest compression [55 sec in A-CPR, 82 sec in C-CPR, p&lt; 0.001], time to first shock delivery [40 sec in A-CPR, 51 sec in C-CPR, p= 0.001] were significantly shorter in A-CPR group than C-CPR group, respectively. Chest compression fraction showed a significant higher in A-CPR than C-CPR [57% in A-CPR, 54% in C-CPR, p &lt;0.001]. Conclusions: The A-CPR device demonstrated significant time savings effect than conventional mechanical CPR device and automated external defibrillation device. In addition, A-CPR and C-CPR showed similar hemodynamic effects and resuscitation outcomes in a swine model of cardiac arrest

Abstract 405: Characteristics and Care of Pediatric Out-of-Hospital Cardiac Arrest in the National Emergency Medical Services Information System

Background: Pediatric out-of-hospital cardiac arrest (OHCA) is an infrequent event with variations in clinical performance in the United States. Recent data on national incidence and treatments provided by Emergency Medical Services (EMS) clinicians during these events is unclear. We sought to characterize the incidence, medications, and procedures performed on children presenting with OHCA. Methods: We evaluated EMS responses in the US using 2021 National Emergency Medical Services Information System (NEMSIS) data. We included children (age ≥1 day - 17 years) with 9-1-1 responses. We identified OHCA events by those with reported: 1) cardiac arrest, 2) EMS resuscitation attempt, 3) EMS CPR performance, or 4) EMS defibrillation. We determined the incidence of pediatric out-of-hospital cardiac arrest among EMS responses and evaluated patient demographics (age, sex, race, location, urbanicity) and clinical interventions (medications, airway procedures). Results: Among 1.74 million pediatric 9-1-1 responses in 2021, we observed 13,040 OHCA events and an overall incidence of 7.6 per 1,000 pediatric 9-1-1 responses. For OHCA events, the median age was 3 years (IQR 0.33,14); 33% of events occurred in children less than one-year-old and 30% in adolescents aged 13-17. Most patients were male (58%) and events occurred mainly in urban settings (79%) and homes (63%). Of this population, 12% received defibrillation, 41% epinephrine, and 27% an advanced airway (endotracheal intubation or supraglottic airway). Conclusions: Pediatric OHCA incidence was low and followed a biphasic pattern by age. As expected in the pediatric population, defibrillation rates were low. One-quarter of patients received an advanced airway. Epinephrine, recommended for all cardiac arrests, was found to be administered in less than half of these events. Further studies are needed to evaluate barriers to optimal OHCA management in pediatric patients in prehospital settings.

Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia.

Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.

Effectiveness of rescue Me CPR! smartphone app providing real-time guidance to untrained bystanders performing CPR

BackgroundOut-of-hospital cardiac arrest (OHCA) is a persistent global health challenge, owing, in part, to low rates of population CPR training. Smartphone applications have the potential to widely disseminate CPR basic training to a populace, but other studies have found multiple limitations in previously developed CPR guidance applications (CPR-GA). This study aims to use medical simulation to assess the relative CPR performance of novices using the ‘Rescue Me CPR!’ (RMC) app, a custom CPR-GA designed by this research team, to novices using ‘PG-CPR!’ (PGC), the most downloaded CPR-GA available in the USA, and to CPR certified medical personnel. MethodsIn a prospective randomized experimental trial of 60 individuals, subjects were either given the RMC app, the PGC app, or had active CPR certification. They were presented a cardio-pulmonary arrest scenario and were observed while performing CPR on a high-fidelity manikin. Data was collected through four cycles of CPR, during which time 24 pertinent performance metrics and CPR steps were timed and recorded. These metrics were assessed on their own and used to calculate average time to compressions, average chest compression fraction, and rate of high-quality CPR for each study group. ResultsCPR certified subjects called 911 in 100 % of simulation cases, started compressions 34 ± 10 s after first seeing the simulated patient, had an average chest compression fraction of 0.52, and performed high-quality CPR in 25 % of aggregate compression cycles. PGC app users called 911 in 70 % of simulation cases, started compressions 86 ± 17 s after first seeing the simulated patient, had an average chest compression fraction that could not be assessed due to inconsistent pauses during CPR, and performed high-quality CPR in 2.5 % of aggregate compression cycles. RMC app users called 911 in 100 % of simulation cases, started compressions 55 ± 6 s after first seeing the simulated patient, had an average chest compression fraction of 0.48, and performed high-quality CPR in 50 % of aggregate compression cycles. ConclusionThe results of this study demonstrate that in all studied metrics, except time-to-first-compression, CPR provided by individuals using the RMC app is statistically equivalent or superior to CPR performed by a CPR certified individual and, in almost every metric, superior to CPR performed by users of the most downloaded android CPR guidance application, PG-CPR.

Efficacy of a healthcare provider basic life support simulation program

This study is conducted to assess if frequent simulation training to improve defibrillation and CPR performance impacts staff skill and knowledge retention. Healthcare providers self-efficacy level was measured using a questionnaire to collect pre- and post-survey data. Data on performance was collected during the training. Performance measures improved significantly on all key constructs (p<0.001). Various age, education, medical occupation, and years in healthcare and with BLS training were statistically correlated with education/medical competencies skills. These findings support frequent unit-based training sessions increase skill set and confidence levels leading to better performance on life-saving steps during CPR.

An Evaluation of Nurse Anesthetists’ Acquisition and Retention of Knowledge and Skill Performance for Brief Basic Life Support and Advanced Cardiac Life Support Training

OBJECTIVE The purpose of this study was to evaluate the acquisition and retention of knowledge and skills of basic (BLS) and advanced cardiac life support (ACLS) for nurse anesthetists at Maharaj Nakorn Chiang Mai Hospital. METHODS The one-group pretest-posttest design study was used. BLS and ACLS training comprised a brief BLS and ACLS review and practice. Knowledge was assessed by multiple-choice questions. The BLS skills were assessed by observing CPR performance on a Resusci- Anne-skill meter manikin and ACLS skills were evaluated using ACLS scenarios. The knowledge and skills were assessed before and after the training weekly for four weeks, and then at three months after the training ended. RESULTS A total of 38 nurse anesthetists participated in the study. There were significant increases in BLS and ACLS knowledge and skills after the training. However, there was short retention of BLS and ACLS knowledge and skills at three months after the training. Foreign body airway obstruction and assessing unresponsiveness were the two most common of BLS skills degradation. While the primary and secondary assessment, assessing ACLS algorithms, electrocardiogram recognition and electrical therapy were the common skills performance of ACLS skills degradation. CONCLUSIONS After the BLS and ACLS training, the knowledge and skills were significantly improved but there was short retention of knowledge and skills at three months after the training. Regular refreshment of CPR education is recommended to enhance the retention of knowledge and practice of nurse anesthetists KEYWORDS knowledge and skills retention, nurse anesthetists, acquisition, basic life support, advanced cardiac life support

Who is the real team leader? Comparing leadership performance of the team leader and CPR Coach during simulated cardiac arrest

PurposeTo describe the leadership performance of team leaders and CPR Coaches, and to determine if there is a correlation between leadership scores and CPR performance during management of simulated pediatric cardiac arrest events. MethodsThis is a secondary analysis of data from a prior randomized controlled trial. We observed the performance of both team leaders and CPR coaches during the management of an 18-minute simulated cardiac arrest scenario which was run for 20 resuscitation teams comprised of CPR-certified professionals from four pediatric tertiary care centers. CPR Coaches were responsible for providing real-time verbal feedback of CPR performance to compressors. Two raters were trained to use the Behavioral Assessment Tool (BAT) to assess leadership performance of the team leader and CPR Coach. BAT scores of team leaders and CPR coaches were compared and linked with objective CPR performance. ResultsThere was no significant difference between the BAT scores of team leaders and CPR coaches (median score 27/40 vs 28.8/40, p = 0.16). Higher BAT scores of team leaders were significantly associated with higher percentage of excellent CPR (r = 0.52, p = 0.02), while higher BAT scores of CPR coaches were significantly associated with higher chest compression fraction (r = 0.48, p = 0.03). ConclusionsBoth team leaders and CPR coaches have similarly high leadership performance during the management of simulated cardiac arrest. Leadership behaviors were associated with quality of CPR performance.Clinical Trial Registration: Registration ID: NCT02539238; https://www.clinicaltrials.gov.

Using real-time device-based visual feedback in CPR recertification programs: A prospective randomised controlled study

BackgroundReceiving regular training to maintain CPR skills is critical for in-service health-care professionals, especially because motor skills diminish over time. ObjectivesTo compare the effects of real-time device-based visual feedback and conventional instructor-based feedback on the chest compression skills and self-efficacy of nurses receiving a CPR recertification program. DesignA prospective randomised controlled study with repeated measurements was conducted according to the CONSORT 2010 guidelines. MethodsA total of 109 nurses were recruited, and 98 nurses were eligible for random allocation. The control group (CG, n = 49) was advised by instructors for skill correction, and the experimental group (EG, n = 49) adjusted their skills according to on-screen real-time feedback data. The study outcomes were CPR performance metrics and self-efficacy that were assessed immediately after the training session (T1) and retested after 12 weeks (T2). ResultsIn the EG, the percentage of the appropriate rate, depth, and chest recoil at T1 significantly improved by 24.47 % (P < .001), 19.63 % (P < .001), and 11.52 % (P = .001), respectively. The EG exhibited significantly higher chest compression total scores at T1, and the difference remained significant at T2 (P < 0.001). Moreover, the self-efficacy in the EG significantly improved at T1 (2.76; P < .001) and T2 (2.58; P < .001). ConclusionCompared with instructor-based feedback, real-time device-based visual feedback improved chest compression quality and CPR self-efficacy.

CPR Quality Assessment in Schoolchildren Training.

Whilst CPR training is widely recommended, quality of performance is infrequently explored. We evaluated whether a checklist can be an adequate tool for chest compression quality assessment in schoolchildren, compared with a real-time software. This observational study (March 2019-2020) included 104 schoolchildren with no previous CPR training (11-17 years old, 66 girls, 84 primary schoolchildren, 20 high schoolchildren). Simultaneous evaluations of CPR quality were performed using an observational checklist and real-time software. High-quality CPR was determined as a combination of 70% correct maneuvers in compression rate (100-120/min), depth (5-6 cm), and complete release, using a real-time software and three positive performance in skills using a checklist. We adjusted a multivariate logistic regression model for age, sex, and BMI. We found moderate to high agreement percentages in quality of CPR performance (rate: 68.3%, depth: 79.8%, and complete release: 91.3%) between a checklist and real-time software. Only 38.5% of schoolchildren (~14 years-old, ~54.4 kg, and ~22.1 kg/m2) showed high-quality CPR. High-quality CPR was more often performed by older schoolchildren (OR = 1.43, 95%IC:1.09-1.86), and sex was not an independent factor (OR = 1.26, 95%IC:0.52-3.07). For high-quality CPR in schoolchildren, a checklist showed moderate to high agreement with real-time software. Better performance was associated with age regardless of sex and BMI.

The impact of a high-performance cardiopulmonary resuscitation protocol on survival from out-of-hospital cardiac arrests witnessed by paramedics

AimIn this study, we examine the effect of a high-performance cardiopulmonary resuscitation (HP-CPR) protocol on patient outcomes following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) personnel. MethodsWe performed a retrospective cohort study of adult, EMS witnessed OHCA patients of medical aetiology in Victoria, Australia. Patients treated after the introduction of a HP-CPR protocol and training programme between February 2019 and January 2020 were compared to historical controls between January 2015 and January 2019. The effect of a HP-CPR protocol on survival to hospital discharge was examined using logistic regression models adjusted for arrest factors. ResultsA total of 1,561 and 420 EMS witnessed OHCA patients were treated in the control and intervention periods, respectively. Baseline characteristics were mostly balanced across study periods, except for an initial arrest rhythm of asystole which was more frequent during the intervention period (20.2% vs 15.9%; p-value = 0.04). Unadjusted survival to hospital discharge was similar across control and intervention periods for the overall population (32.1% vs 29.4%, p-value = 0.27), but significantly higher during the intervention period for initial shockable arrests (76.9% vs 66.6%; p-value = 0.03). After adjustment for confounders, cases in the intervention period were associated with an improvement in the adjusted odds of survival to hospital discharge for overall arrests (adjusted odds ratio [AOR] 1.37, 95% CI: 1.00–1.88) and initial shockable arrests (AOR 1.70, 95% CI: 1.03–2.82). ConclusionThe implementation of a HP-CPR protocol was associated with a significant improvement in survival from EMS witnessed OHCA. Efforts to improve CPR performance could yield further improvements in patient outcomes.

Abstract 233: Chest Compression Release Velocity In Pediatric In Hospital Cardiac Arrest: A Descriptive Study

Introduction: Chest compression release velocity (CCRV) during chest compression (CC) recoil is understudied in pediatrics. Our objective was to characterize CCRV during pediatric in hospital cardiac arrest (IHCA). Methods: Using the PediRES-Q multicenter prospective observational cohort from 2015 to 2021, we analyzed patients &lt;18 years who received ≥ 20 minutes of CPR with quantitative CPR metrics (ZOLL R Series) across 30 sites. Median and Interquartile Range (IQR) CCRV, measured by pad integrated accelerometers, was defined as maximum velocity during CC recoil. CCRV was calculated for each CC and compared between 3 age groups. Initial (min 0-3), early (min 5-8), and late (min 15-20) periods of CPR were compared when metrics were available for all stages. Wilcoxon rank sum was used for comparisons. Results: Of 308 events with CC metric data and ≥ 20 min duration there were 106 (34%) &lt;1 yo, 114 (37%) 1&lt;8 yo, and 88 (29%) 8&lt;18 yo. Median [IQR] duration was 43 [31, 58] min. Median CCRV for &lt;1 yo: 152 [125, 179] mm/s; 1&lt;8 yo: 213 [177, 261] mm/s; and 8&lt;18 yo: 397 [294, 388] mm/s. Difference in CCRV between age groups was significant (p&lt;0.0001) with CCRV increasing as age increased. 185 events had complete CC metric data during initial (min 0-3), early (min 5-8), and late (min 15-20) periods of CPR. There was no significant difference in CCRV over time: initial 222 [159, 329] mm/sec; early 218 [154, 322] mm/sec; late 219 [163, 321] mm/sec. Similar lack of difference over time was demonstrated between the 3 age groups: &lt;1 yo initial 151 [113, 191] mm/sec; early 149 [119, 191] mm/sec; late 160 [127, 213] mm/sec; 1&lt;8 yo initial 222 [177, 277] mm/sec; early 237 [186, 276] mm/sec; late: 220 [185, 256] mm/sec; and 8&lt;18 yo initial 376 [270, 524] mm/sec; early 395 [277, 441] mm/sec; late 381 [280, 468] mm/sec. Conclusions: We characterized CCRV during pediatric IHCA as a metric of CPR performance related to chest recoil. CCRV was significantly slower for &lt;1 yo, faster for 1 to &lt;8 yo, and fastest for 8 to &lt;18 yo. Surprisingly, CCRV was not different over time (initial, early, late CPR periods). These findings suggest differences in CCRV related to patient age but do not demonstrate changes in CCRV over time in the first 20 minutes of CPR.

Abstract 148: No Bystander Cardiopulmonary Resuscitation For Out-Of-Hospital Cardiac Arrest In Vietnam: Impact On The Outcomes

Introduction: Bystander CPR is not often performed on OHCA patients, particularly in limited-resource regions. This study aimed to investigate the rate of OHCA patients who did not receive bystander CPR and its impact on the outcomes in an LMIC. Hypothesis: Understanding the reasons bystanders are reluctant to call EMS and how no bystander CPR impacts the outcomes of OHCA patients are crucial for improving survival in Vietnam. Methods: We performed a multicenter prospective cohort study of OHCA patients (≥18 years) presenting to three central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes and compared these data between patients who did not receive bystander CPR and patients who did. Using logistic regression, we assessed factors associated with survival and good neurological function on discharge (a CPC score of 1 or 2). Results: Of 521 patients, 388 (74.5%) were male, and the mean age was 56.71 years (SD: 17.32). Although most cardiac arrests (68.7%; 358/521) occurred at home and 67.9% (353/520) were witnessed by bystanders, a high rate (77.9%, 406/521) of these patients did not receive bystander CPR. Only half of the patients were taken by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521); 50.8% (133/262) of whom were given resuscitation attempts by EMS or private ambulance. There was no significant difference in survival to admission (16.7%; 68/406 and 24.3%; 28/115; p=0.064) and survival to discharge (7.9%; 32/406 and 14.8%; 17/115; p=0.094) between patients who did not receive bystander CPR and patients who did. In contrast, the rate of good neurological function of patients who did not receive bystander CPR (4.7%, 19/406) was significantly lower than that of patients who received bystander CPR (12.2%, 14/115; p=0.004). Moreover, multivariate analysis showed that no bystander CPR (OR: 0.276; 95% CI: 0.124-0.614) was inversely and independently associated with good neurological function. Conclusions: In our study, poor outcomes emphasize the need for increasing bystander CPR performance, increasing the number of EMS ambulances and the utilization of private ambulances, and developing a standard emergency first-aid program for both healthcare personnel and the community.

Design of an IoT-Based Remote Learning System for Medical Skill Training in the Age of COVID-19: Focusing on CPR Skill Training

Medical skill education has been scaled down due to the COVID-19 pandemic. In particular, the decrease in CPR skill training has caused the quality of medical services to deteriorate. While new online education methods have emerged, few studies exist on online teaching and its effects. Since the online teaching of medical skills presents several challenges for instructors, it has not been as effective as face-to-face training. This study designed a new remote system focusing on medical skill education. The proposed video-based application prototype uses an IoT device to measure CPR performance metrics and provides real-time data to users. It was tested using the Kano model on a small group of subjects. The effects of skill training were analyzed quantitatively and qualitatively. A comparative analysis of the remote group and face-to-face group revealed similar average values for appropriate compression depth. In other categories, the remote group fared poorer than the face-to-face group. Considering the high scores given to system usability in the USE survey, remote education shows promise as an alternative to face-to-face education. The significance of this study lies in being the first to develop and test a remote education system for medical skill training in the age of COVID-19.

Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study

BackgroundT-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival.ObjectiveTo evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan.MethodsA cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant.ResultsThere were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.).ConclusionOur results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.

Association between serum potassium levels and short-term mortality in out-of-hospital cardiac arrest survivors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation The Danish Foundation TrygFonden Background Serum potassium levels outside the normal range are associated with increased short-term mortality in patients with acute cardiovascular disease such as acute heart failure. In survivors of out-of-hospital cardiac arrest (OHCA), the initial serum potassium concentration is often outside the normal range. However, it is unknown whether there is an association between initial serum potassium level and short-term mortality in OHCA survivors. Purpose The aim of this study was to describe potential associations between serum potassium level and 30-day survival in patients surviving OHCA. Methods We identified 1630 patients who had return of spontaneous circulation (ROSC) at hospital arrival, and a registered post-OHCA serum-potassium value, using Danish nationwide registry data from 2001-2015. Thirty-day survival was analyzed according to the following seven predefined potassium levels: &amp;lt;2.5, 2.5-2.9, 3.0-3.4, 3,5-4.6, 4.7-5.5, 5.5-6.0, &amp;gt;6.0 mmol/L. Thirty-day survival was estimated using a multivariable Cox regression (reference normokalemia 3.5–4.6 mmol/L). The multivariable model included age, sex, Charlson comorbidity index, witnessed status, performance of CPR and first registered heart rhythm. Results During 30-day follow-up, survival in the seven strata was 29 (55.8%), 52 (61.9%), 167 (63.3%), 543 (58.7%), 66 (35.5%), 12 (28.6%), and 18 (23.4%), respectively. Standardized average risk ratios (ARR) of 30-day survival was significantly lower for all groups with hyperkalemia compared with normokalemia: 4.7-5.5 mmol/L: (ARR: 0.86, 95% confidence interval (95% CI): 0.74–0.96); 5.5-6.0 mmol/L: (ARR: 0.76, 95% CI: 0.52–0.98); &amp;gt;6.0 mmol/L: (ARR: 0.64, 95% CI: 0.50–0.79). Survival did not differ significantly in patients with hypokalemia compared with normokalemia: &amp;lt;2.5 mmol/L: (ARR: 0.87, 95% CI: 0.68–1.06); 2.5-2.9 mmol/L: (ARR: 1.06, 95% CI: 0.93–1.19); 3.0-3.4 mmol/L: (ARR: 1.01, 95% CI: 0.93–1.10). Conclusions In OHCA survivors, hyperkalemia was associated with reduced 30-day survival compared with normokalemia. This association was independent of age, sex, Charlson comorbidity index, witnessed status, performance of CPR and first registered heart rhythm. Conversely, hypokalemia was not associated with reduced 30-day survival in this patient population.

Impact of cardiopulmonary resuscitation duration on the neurological outcomes of out-of-hospital cardiac arrest

BackgroundPatients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.ObjectivesThe study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.MethodsThis is a quantitate cross-sectional study where data is collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between January 2015 and December 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death. The outcome is the survival of OHCA or death, and the neurological outcome by the cerebral performance category (CPC) score for survivors. A score of 1 or 2 defined as good CPC outcome and 3, 4, and 5 as poor outcome.ResultsThe mean for the duration of emergency CPR procedures in surviving patients is 26.5 ± 7.20 min, whereas in patients who died after the procedure it is 29.6 ± 9.15 min. Bivariate analysis showed no significant association between duration of CPR and Cerebral Performance Category (CPC) outcome but could be significant if the sample size is large. Age, however, is significantly related to the survivorship of OHCA and to a better CPC outcome. Younger patients are more likely to have better CPC outcome. A good CPC outcome was reported with a limited duration of 8.1 min of CPR, whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min.ConclusionCardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Variables such as the patient population's uniqueness, underlying medical conditions, or the specific study conditions may explain this variance between the bivariate analysis and the study conclusion. Therefore, a more comprehensive study is recommended in future.