Current European Resuscitation Council Guidelines Research Articles

IS CARDIOPULMONARY RESUSCITATION OUTCOME IN PRE-HOSPITAL EMERGENCY MEDICINE RELATED TO AIRWAY MANAGEMENT TECHNIQUE?

According to current European Resuscitation Council guidelines, priorities in advanced life support in adult are chest compression with minimal interruption and early defibrillation. Endotracheal intubation is still considered the gold standard in airway management, but guidelines suggest that securing the airway be incremental, ranging from basic techniques to more complex ones. Doctors who work in pre-hospital emergency medicine teams (EMT) in Croatia usually lack sufficient education and expertise. The aim of this study was to determine whether there was a significant difference in recovery of spontaneous circulation during cardiopulmonary resuscitation (CPR) in out-of-hospital setting depending on the EMT airway management technique of choice. This retrospective analysis included data collected during a 10-year period at the Krapina-Zagorje County Emergency Medicine Institute on all patients with CPR performed by EMTs 20 minutes from initial emergency call. The airway management groups included oropharyngeal tube, i-gel supraglottic device, and endotracheal tube. There were 968 patients, mean age 70. In 74.61% of patients, the cause of arrest was of cardiac etiology. Our study did not find a statistically significant in difference of CPR success among the three groups analyzed according to the airway management technique of choice (p=0.74, χ2-test).

Analysis of Emergency Medical Response Team Performance during the International Winter Championships in Emergency Medicine.

Background and Objectives: Conducting advanced life support (ALS) according to the guidelines of the European Resuscitation Council (ERC) requires medical personnel to implement the appropriate emergency actions. In particular, these actions include chest compressions, airway management, artificial ventilation, defibrillation and the administering of medicines. An appropriate training system enables members of medical response teams (MRT) to acquire the essential knowledge and skills necessary to correctly conduct cardiopulmonary resuscitation (CPR). One way to improve the quality of interventions by MRT personnel is participation in emergency medicine championships. Materials and Methods: The research analysed assessment cards for tasks carried out during the International Winter Championships in Emergency Medicine in the years 2013-2020. The assessed tasks were prepared and led by European Resuscitation Council instructors of advanced life support. During ten-minute scenarios of simulated sudden cardiac arrest (SCA) in adults, the judges assessed the compliance of procedures with current ERC guidelines. This research analysed the performance of 309 teams from Poland made up of paramedics from medical response units from all over the country. Results: In most cases, the study showed significant differences in the percentage of correctly performed procedures between years. Most often, the highest percentage of correctly performed procedures was recorded in 2019 and 2020. The lowest percentage of correctly performed procedures was most often recorded in 2013. In subsequent years, the percentage of use of tracheal intubation decreased (from 54.76% to 31.25%) in favour of an increase in the use of supraglottic airway device SAD (from 35.71% to 59.38%). Conclusions: The research has shown that in subsequent years of the Championships, the quality of the majority of assessed procedures carried out by members of MRT gradually improved. The research authors also observed that in subsequent years, the percentage of intubations decreased in favour of SAD.

KNOWLEDGE OF IN-HOSPITAL CARDIOPULMONARY RESUSCITATION AMONG NURSING STAFF

Aim: To assess the knowledge of medical personnel about in-hospital cardiopulmonary resuscitation and to compare it with the current European Resuscitation Council Guidelines. Furthermore, the study intended to investigate the respondents’ preferences and experiences associated with performing cardiopulmonary resuscitation. Material and methods: The study included 248 nurses working in conservative and surgical wards. The research used an author-designed survey questionnaire, which was made available in electronic form. It consisted of 20 closed single-choice questions. Participation in the study was anonymous and voluntary. Results: A high level of knowledge of in-hospital CPR was found in 30.6%, average in 50.4% and low in 19%. Re¬spondents with work experience of ≤2 years (43.2%) and 3-10 years (36%) were significantly more likely to have a high level of knowledge of in-hospital CPR than those with longer work experience, especially 11-25 years (13.6%), p<0.0001. Most of respondents reported that the type of equipment used for defibrillation did not matter to them (42.3%), while 27.8% preferred the use of a defibrillator spoon, and 29.8% preferred the use of self-adhesive elec¬trodes for defibrillation. The majority of respondents (70.2%) used 1 mg undiluted epinephrine during CPR. A dose of 1 mg epinephrine after 10-fold dilution in 0.9% NaCl solution was used by 20.2% of respondents. Conclusions: The study showed an average level of knowledge on in-hospital cardiopulmonary resuscitation. A signif¬icantly higher level of knowledge was found in younger respondents, those with shorter work experience and higher education, and among men. The type of equipment used during defibrillation did not matter for most respondents. It was also found that the vast majority of respondents had participated in or witnessed cardiopulmonary resuscitation at least once, and more than half knew the professional qualifications gained after a qualification course and speciali-sation in anaesthesia and intensive care nursing.

Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention.

Objective: Resuscitation of neonates after birth in the out-of-hospital setting is challenging. Thus, we aimed to assess paramedics' newborn life support knowledge and skills before and after targeted simulation-based training.Methods: Voluntary paramedics were recruited from a single Red Cross division. During a 1-day simulation-based educational intervention, essential aspects of neonatal resuscitation were taught and practiced. Before and after simulation-based training, we assessed (1) knowledge of current European Resuscitation Council (ERC) guidelines using a 20-item-questionnaire and (2) the quality of simulated bag-valve-mask ventilation by measuring face mask leakage, using a respiratory function monitor (Standardized Measurement of Airway Resuscitation Training [SMART], GM Instruments Ltd., United Kingdom).Results: Forty-one paramedics participated in the initial survey and 12 took part in the simulation-based educational intervention. There was a significant increase in the number of correctly answered questions: median 62.1% (IQR 37.5–77.4%) vs. 91.7% (IQR 83.3–100%; p = 0.001). A total of 1,332 inflations were analyzed. The incidence of substantial mask leakage >75% decreased significantly after training (15.8 vs. 6.1%; p < 0.001), while median mask leakage was similar (17.0% [IQR 0.0–55.0%] vs. 18.0% [IQR 6.0–34.0%]; p = 0.414).Conclusions: Among paramedics, theoretical knowledge of current ERC guidelines was moderate in this study. Participation in a targeted simulation-based educational intervention was associated with a significant increase in theoretical knowledge. The initially high incidence of substantial mask leakage >75% was decreased after simulation-based training using respiratory function monitoring.

Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students’ practical skills and willingness to act: a cluster randomised trial

ObjectivesThe aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students’ practical skills and...

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

Aim of the studyMany hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory. MethodsAll healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data. ResultsFor each year of the study period (2008–2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P=0.073). ConclusionThe NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest.

Needle, knife, or device – which choice in an airway crisis?

Needle, knife, or device – which choice in an airway crisis?

1552 Improving Control of the Oxygen Saturation During Resuscitation of Preterm Infants with the use of Trend Monitoring

BackgroundThe European Resuscitation Council (ERC) guidelines prescribe oxygen saturation (SpO2) targets for the first 10 minutes of resuscitation after birth. Unfortunately, the control of SpO2 in newborn infants is difficult.ObjectivesTo...

Intraosseous access education on an Advanced Life Support courseCategory: Advanced Life Support

Purpose of the study: Current European Resuscitation Council guidelines for resuscitation recommend IO route for delivery of drugs if intravenous (IV) access cannot be achieved.1 The purpose of this study was to assess the feasibility, educational and clinical value of introducing a vascular access station on the Advanced Life Support (ALS) course.

Survival to discharge following Open Chest Cardiac Compression (OCCC). A 4-year retrospective audit in a cardiothoracic specialist centre—Royal Brompton and Harefield NHS Trust, United Kingdom

Objective: To review the use of Open Chest Cardiac Compression (OCCC) techniques in postcardiac surgical patients in one specialist cardiothoracic centre in the UK. Methods: A 4-year retrospective audit (April 1995–March 1999) of all cardiac arrest victims and resuscitation practice across two specialist cardiothoracic hospitals. Audit outcomes related to initial survival and survival to discharge, arrest rhythm, reasons for resternotomy, surgical procedure prior to resternotomy and time elapsed from original surgery to resternotomy. Results: Seventy-two patients (adult and paediatric) suffering cardiac arrest received OCCC following cardiac surgery. Thirty-three patients initially survived (46%) and 12 patients survived to discharge (17%). Discussion and recommendations: In the absence of current European Resuscitation Council guidelines, we adopted recommendations for resternotomy to be performed after 5 min of unsuccessful conventional CPR and OCCC initiated. An adapted ERC algorithm incorporating these recommendations can provide much needed direction in postcardiac surgery cardiac arrest victims.

Paediatric basic life support: a practical assessment

Current European Resuscitation Council (ERC) guidelines for paediatric basic life support advocate delivery of 20 cycles/min at a compression rate of 100/min and a compression:ventilation ratio of 5:1 (Resuscitation 1997;34:115–27; Resuscitation 1998;37(2):97–100). We have evaluated whether cardiopulmonary resuscitation (CPR) can be delivered at this rate by hospital providers. We recruited 24 rescuers, all of whom had successfully completed a training course in paediatric life support. Each was asked to perform single rescuer CPR on a Resusci-Junior ® mannequin (Laerdal, Kent, UK) for 5 min, following the current ERC guidelines. Compressions and ventilations were recorded in real time by inductance plethysmography. Maintenance of the 5:1 ratio was ensured by investigator observation. Cycles of CPR in the first and fifth minutes of resuscitation were counted. The average duration of compression, ventilation and ‘transfer time’ spent between these two activities was calculated as a percentage of the average duration of a cycle of CPR. All 24 rescuers completed 5 min of resuscitation. Twenty-three of 24 were unable to deliver 20 cycles of CPR in either the first minute (range 8–27; median 11; interquartile range (IQR) 10–13.75) or in the fifth minute (8–26; 11.5; 10–13.75). The median (IQR) duration of a cycle of CPR was 5 s in the first and fifth minutes. Transfer time comprised 30% of total cycle time. In this study, over 95% of single rescuers trained in paediatric life support were unable to deliver 20 cycles of CPR/min. The guidelines make no allowance for time spent moving between compression and ventilation activity. Future consensus statements should take account of this transfer time. Any changes in recommendations should obviously be prospectively audited with Utstein-style reporting and studies of practicability.

ResusSim 98—a PC advanced life support trainer

Advanced life support (ALS) requires several different skills and the recall of complex information. The personal computer is an ideal tool for the teaching of factual information. We have developed a computer programme that simulates a variety of cardiac arrest scenarios. Its aim is to communicate specialist knowledge to junior staff in a challenging and entertaining way. Each scenario has a real time ECG, clinical signs of the simulated patient, blood pressure, oxygen saturation and temperature. Arterial blood samples can be analysed and the medical record can be reviewed. Interventions available include defibrillation, intubation, fluid and drug therapy. Built-in variation means that repeating a scenario may lead to different patient behaviour. An important part of the programme is the intelligent debriefing of the user after each patient. Each action elicits a comment that is based upon the current European Resuscitation Council guidelines. This is then hyperlinked to an extensive help file that includes the text of the guidelines, diagrams, pictures and algorithms that aid the user in the learning of ALS skills in association with existing teaching programmes. ResusSim 98 runs under Windows 3.1, Windows 95/98 and Windows NT 4.0.