Delivery Of Chest Compressions Research Articles

Proportional Versus Fixed Chest Compression Depth for Guideline-Compliant Resuscitation of Infant Asphyxial Cardiac Arrest

ABSTRACT OBJECTIVES Current guidelines for parameters of the delivery of chest compressions (CC) for infants and children are largely consensus based. Of the two recommended depth targets – 1.5 inches and 1/3 anterior-posterior chest diameter (APD) – it is unclear whether these have equal potential for injury. In previous experiments, our group showed in an animal model of pediatric asphyxial out-of-hospital cardiac arrest (OHCA; modeling ∼ 7 year-old children) that 1/3 APD resulted in significantly deeper CC and a higher likelihood of life-threatening injury. We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant model of asphyxial OHCA. METHODS Swine were sedated, anesthetized, paralyzed, intubated through direct laryngoscopy, and then mechanically ventilated (10ml/kg, FiO2:21%). APD was measured and confirmed by two investigators via a sliding T-square at the xiphoid. After instrumentation for vital signs monitoring, and while still anesthetized, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 minutes. Animals were then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. Advanced life support drugs were administered at 13 minutes, and defibrillation at 14 minutes. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 minutes of failed resuscitation. Survivors were sacrificed with KCl after 20 minutes of observation. Veterinary staff conducted necropsy to assay lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Injury characteristics were summarized and compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05. RESULTS A total of 36 animals were included for analysis (Group 1: 18; Group 2: 18). Mean (SD) APD overall was 5.58 (0.23) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups. No injury characteristics differed significantly between groups. CONCLUSIONS In an swine model of infant asphyxial OHCA and resuscitation considering 1/3 APD or 1.5 inches, neither CC depth strategy was associated with increased injury.

Family presence during in-hospital cardiopulmonary resuscitation: effects of an educational online intervention on self-confidence and attitudes of healthcare professionals.

Guidelines support family-witnessed resuscitation (FWR) during cardiopulmonary resuscitation in hospital if deemed to be safe, yet barriers amongst healthcare professionals (HCPs) still exist. This study aimed to evaluate the effects of an educational online video intervention on nurses' and physicians' attitudes towards in-hospital FWR and their self-confidence in managing such situations. A pre- and post-test quasi-experimental study was conducted October 2022 to March 2023 at six Swedish hospitals involving the departments of emergency care, medicine, and surgery. The 10 min educational video intervention was based on previous research covering the prevalence and outcome of FWR, attitudes of HCP, patient and family experiences, and practical and ethical guidelines about FWR.In total, 193 accepted participation, whereof 91 answered the post-test survey (47.2%) with complete data available for 78 and 61 participants for self-confidence and attitudes, respectively. The self-confidence total mean scores increased from 3.83 to 4.02 (P < 0.001) as did the total mean scores for attitudes towards FWR (3.38 to 3.62, P < 0.001). The majority (71.0%) had positive views of FWR at baseline and had experiences of in-hospital FWR (58.0%). Self-confidence was highest amongst participants for the delivery of chest compressions (91.2%), defibrillation (88.6%), and drug administration (83.3%) during FWR. Self-confidence was lowest (58.1%) for encouraging and attending to the family during resuscitation. This study suggests that a short online educational video can be an effective way to improve HCP's self-confidence and attitudes towards the inclusion of family members during resuscitation and can support HCP in making informed decisions about FWR.

Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study

Introduction Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. Objective We examined the barriers to initiation of T-CPR. Methods We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). Results We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., “snoring”, “slow”) or to confirm that breathing was effective in an unconscious victim. Conclusions We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.

An Evaluation of the Quality of CPR Chest Compressions Performed on Football-Equipped and Obese Simulation Manikins

Objective Protective athletic equipment may hamper the delivery of effective chest compressions. Unfortunately, an algorithm for managing cardiac arrest emergencies with equipment-laden athletes has yet to be established by national CPR certifying agencies. Further, athletes classified as being overweight or obese carry adipose in the thoracic region, which has been reported to inhibit the ability of rescuers to provide quality chest compressions. Thus, the purpose of this study was two-fold. The first purpose was to assess the ability of emergency responders to perform CPR chest compressions on an obese manikin. The second purpose was to analyze the effect of American football protective equipment on the performance of chest compressions by emergency responders. Methods Fifty emergency responders completed four 2-minute bouts of compression-only CPR. The scenarios included performing chest compressions on both traditional and obese CPR manikins, and performing chest compressions over a set of shoulder pads/chest protector that is used in the sport of American football on both traditional and obese manikins. Results The most notable outcomes in this study were related to chest compression depth, which fell well below the minimum recommended depth published by the American Heart Association in all conditions. Mean compression depth was significantly lower when performed on the obese manikin (avg over pads = 32.8, SD = 9.2 mm; avg no pads = 38.2, SD = 9.1 mm) compared to the traditional manikin (avg over pads = 40.0, SD = 10.9 mm; avg no pads = 40.8, SD = 14.8 mm), with statistical analyses revealing a significant effect due to both manikin size (p < 0.001) and the presence of equipment (p = 0.003), and a statistically significant interaction effect (p = 0.035). Chest recoil data revealed a statistically significant effect due to both manikin size (p = 0.017) and the presence of chest/shoulder safety pads (p = 0.003). Conclusion Within this sample of emergency responders, chest compressions were adversely affected both by the equipment and obesity. Additionally, the traditional manikin received comparable chest compressions regardless of the presence or absence of football protective equipment, albeit both conditions resulted in poor depth performance.

No Code-The Role of Sodium Bicarbonate and Naloxone in Neonatal Resuscitation.

Resuscitations in neonates and infants present caregivers with challenging decisions in a highly stressful environment. Consideration of the pathophysiology of cardiac arrest and respiratory failure prior to an emergency allows for thoughtful utilization of pharmacotherapy. It is vital to remember that establishment of an airway and delivery of breaths and chest compressions should be prioritized. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest unresponsive to the provision of respiratory support and chest compressions. Sodium bicarbonate may be considered based on the intrinsic links between cardiac arrest, respiratory failure, and mixed acidosis. However, experimental and clinical data suggest that sodium bicarbonate worsens myocardial performance by several mechanisms (decreased intramyocardial pH, reduced oxygen delivery to tissues, reduced coronary perfusion pressure). Additionally, rapid administration of this hyperosmolar therapy may contribute to intracranial hemorrhage. With no clear benefit and multiple risks, sodium bicarbonate has been excluded from neonatal resuscitation algorithms. Opioids may produce respiratory depression in neonates, whether given to the mother prior to delivery or in neonatal intensive care; therefore, naloxone may be considered to restore respiratory drive. However, 50 years of neonatal utilization has not produced clinical studies documenting efficacy and safety. On the contrary, clinical studies fail to detect clear benefit and numerous concerning adverse reactions have been reported, including acute withdrawal, cardiorespiratory decompensation, and death. For these reasons, naloxone has also been removed from neonatal resuscitation algorithms. Clear understanding of pathophysiology, pharmacology, and clinical data support the use of multiple pharmacotherapies in neonatal resuscitation, including epinephrine, normal saline, intravenous glucose, adenosine, and calcium gluconate as reviewed in a previous column. The same pathways inform confident exclusion of sodium bicarbonate and naloxone.

Know the Code: Medications for Resuscitation in Neonates.

Resuscitations in the delivery room or the nursery cause significant stress for caregivers. Diligent preparation will improve the efficacy and safety of life-saving interventions and increase staff comfort. When establishment of an airway and delivery of positive pressure ventilation and chest compressions fail to result in return of spontaneous circulation, pharmacotherapeutic interventions should be considered. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest, increasing coronary arterial pressure and blood flow during chest compressions. Despite limited data regarding dosing and efficacy, the first dose of epinephrine may be delivered through the endotracheal tube during attainment of venous access (preferably a low-lying umbilical venous catheter in the delivery room). Intravenous dosing is preferred, and any facility caring for newborns must ensure optimized logistics including readily available dosing guidance and optimal flush volumes. After provision of epinephrine, additional medications may be considered, especially for resuscitations occurring outside of the immediate perinatal period, including normal saline, glucose, adenosine, atropine, and calcium. Clinicians must understand the indications, dosing, and monitoring parameters for these medications and ensure rapid availability for resuscitation. Every second truly counts in a neonatal resuscitation, and optimal understanding and preparation will ensure delivery of pharmacotherapy to optimize both patient outcomes and staff comfort.

13 Medical Emergency &lt;i&gt;in situ&lt;/i&gt; Simulation Training for Dental Hygiene Therapists

simulation, in the clinical environment, can help detect any issues with the systems, policies and practices within an organization that may not work. Many system errors go unnoticed until there is a real incident. Conducting simulation This simulation exercise is designed to develop the skillset of foundation dental therapists in respect of Medical Emergency recognition and management in their own working environment. The parameters for assessment included teamwork, knowledge, communication, effectiveness of actions and situational awareness.Research methods for this project included a learning needs analysis, surveying and interviewing previous cohorts of hygiene therapists. The conclusions of which highlighted the need for further training in managing medical emergencies. The learning needs identified from stakeholders relating to this course have been used to develop the learning outcomes using Blooms’ taxonomy Using GIBBs model of reflection, the 2021 delegates recognized personal learning needs including improvement in leadership and management skills, delivery of chest compressions and teamwork. Changes to practice were also recognized, for example, placing their emergency drugs in a more appropriate location. Using video, a ‘Hot Debrief’ method of evaluation was carried out whilst the experience was fresh. This proved to be powerful and enhanced personal reflection to support future learning and development. Later, an evaluation method in the form of a survey took place. Results of which showed that 50% of delegates had never partaken in simulation-based education before and 100% gave an excellent rating on the benefits to team and individual. One participant stated ‘this was such a good, real-life experience! I hope this can either be introduced into undergraduate training or as part of the practice annual BLS CPD!!’.A successful session needed prior communications with the practice staff to free up a surgery for use, inform present patients of the activity and understand where the emergency equipment was during the session for patient safety. The benefits of conducting

Abstract 14213: Injury Characteristics of Chest Compressions in a Swine Model of Infant Asphyxial Cardiac Arrest Using Either 1.5 inch or 1/3 Anterior-Posterior Diameter Depth Targets

Background: Current AHA guidelines for the delivery of chest compressions (CC) for infants and children are largely consensus based, and recommended depths of 1.5 inches or 1/3 anterior-posterior chest diameter (APD). It is unclear whether these have equal potential for injury. Objectives: We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant-sized model of asphyxial OHCA. Methods: Thirty-six juvenile swine weighing 10.6kg +/- 0.84 (approximating the 50 th percentile for a 12-month-old) were anesthetized, paralyzed, intubated, and mechanically ventilated (FiO2 21%). APD was measured and by two investigators via a sliding T-square. After instrumentation, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 minutes. Animals with an organized rhythm after 8 minutes 45 seconds of asphyxia received a single, 3-second transthoracic shock to induce ventricular fibrillation. At 9 minutes, each was then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. ALS drugs were administered after 13 minutes, followed by initial defibrillation attempt at 14 minutes. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 minutes of failed resuscitation. Survivors were sacrificed with KCl after 20 minutes of observation. Veterinary staff blinded to group assignment conducted necropsies to assess lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Characteristics were compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05. Results: Group 1 had n=18 and Group 2 had n=18 animals. Mean (SD) APD overall was 5.58 (0.22) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups (Group 1: 66.7% vs Group 2: 83.33%; p = 0.248. No injury characteristics differed significantly between groups. Airway bleeding rates were noteworthy though not different between groups (Group 1: 18.8% vs Group 2: 42.1%; p = 0.219). Conclusions: In a swine model of infant OHCA and resuscitation, both CC depth strategies had similar injury characteristics.

Abstract 249: Association of Diastolic Blood Pressure and Myocardial Perfusion Pressure with Survival During Pediatric Cardiopulmonary Resuscitation

Introduction: Myocardial perfusion pressure (MPP), defined as the aortic diastolic pressure minus the central venous diastolic pressure, is an important determinant of return of spontaneous circulation (ROSC) in cardiac arrest. However, measuring MPP requires both arterial and venous catheters and is often not possible. When only invasive arterial monitoring is available, diastolic blood pressure (DBP) is suggested as a surrogate for MPP during resuscitation and is also associated with survival after cardiac arrest. Hypothesis: We hypothesized that DBP measured during chest compression delivery would mirror MPP during resuscitation and both would be associated with survival. Methods: We performed a retrospective, secondary analysis of 102 swine resuscitations. Pediatric swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS). MPP and DBP were recorded every 30 s during chest compression delivery. Results: For both survivors and non-survivors, DBP mirrored MPP throughout resuscitation ( Figure 1A, B ). During BLS, both MPP and DBP were significantly greater in survivors (MPP: 8.5 0.6 vs. 1.1 0.5 mmHg; p &lt; 0.0001; DBP 17.3 0.6 vs. 8.7 0.5 mmHg; p &lt; 0.0001). During ALS, MPP and DBP were greater in survivors than non-survivors (MPP: 20.5 1.0 vs. 0.7 0.3 mmHg; p &lt; 0.0001; DBP 32.3 0.9 vs. 8.8 0.2 mmHg; p &lt; 0.0001). During ALS, the magnitude of change in both MPP and DBP after the first epinephrine administration in survivors was greater than in non-survivors (MPP: 24.4 3.3 vs. 4.8 0.9 mmHg; p &lt; 0.0001; DBP: 24.5 3.1 vs. 5.4 0.8 mmHg; p &lt; 0.0001). Conclusion: These observations confirm that both DBP and MPP are associated with survival in cardiac arrest and validate the use of DBP as a surrogate for MPP. Figure 1: Myocardial perfusion pressure (MPP) and diastolic blood pressure (DBP) during BLS and ALS in survivors (A) and non-survivors (B). Arrows indicate administration of epinephrine during ALS.

The use of pressure-controlled mechanical ventilation in a swine model of intraoperative pediatric cardiac arrest.

Current pediatric resuscitation guidelines suggest that resuscitators using an advanced airway deliver 8-10 breaths per minute while carefully avoiding excessive ventilation. In the intraoperative setting, having a dedicated ventilation rescuer may be difficult because of limited personnel. Continuing pressure-controlled mechanical ventilation during resuscitation for intraoperative cardiac arrest reduces personnel needed and the risk of hyperventilation but might risk hypoventilation during chest compression delivery. To determine whether the use of pressure-controlled mechanical ventilation at prearrest settings provides normoxia and normocarbia during resuscitation from cardiac arrest. We retrospectively analyzed combined data from preclinical randomized controlled trials. Two-week-old swine (3-4kg) underwent asphyxia-induced cardiac arrest. Animals were resuscitated with periods of basic and advanced life support. During resuscitation, pressure-controlled mechanical ventilation was delivered at the prearrest respiratory rate, peak inspiratory pressure, and positive end-expiratory pressure. Arterial blood gases were measured prearrest, at 11minutes of asphyxia, and at 8 and 20minutes of cardiopulmonary resuscitation. Piglets (n=154) received pressure-controlled mechanical ventilation before and during cardiopulmonary resuscitation with a peak inspiratory pressure of 14-15cm H2 O, positive end-expiratory pressure of 4cm H2 O, 20 breaths/minute, and an inspiratory:expiratory ratio of 1:2. During asphyxia, the arterial blood gas showed the expected severe hypercarbia and hypoxia. Continuing pressure-controlled mechanical ventilation using prearrest parameters and increasing the FiO2 to 1.0 returned the PaCO2 to prearrest levels and slightly increased the partial pressure of arterial oxygen at 8 and 20minutes of cardiopulmonary resuscitation. In this piglet model of resuscitation from asphyxial arrest, pressure-controlled mechanical ventilation during cardiopulmonary resuscitation at the prearrest ventilator settings with an FiO2 of 1.0 provides adequate oxygenation and restores normocarbia. Clinical investigation is warranted to determine the benefits of continuing pressure-controlled mechanical ventilation at prearrest parameters during pediatric cardiopulmonary resuscitation.

Effect of Instituting Upper Limits for Chest Compression Depth for Laypersons at Six-months After Chest Compression-Only Training: A Randomized Controlled Simulation Study

Context/ research question: Chest compression quality plays a major role in patient outcomes after cardiac arrest. The Japanese cardiopulmonary resuscitation (JRC) guidelines 2015 indicates that chest compression depth should be approximately 5 cm but not more than 6 cm. However, the upper limit of chest compression depth might be a barrier to the delivery of adequate chest compressions by laypersons. We hypothesized that laypersons may be able to perform chest compressions (approximately 5 cm) as per the JRC guidelines, without setting an upper limit for chest compression depth. Methods: Participants were randomly assigned to either the “unlimited group” (no recommendation regarding the upper limit of compression depth) or the “limited group” (“push to approximately 5 cm, don’t push over 6 cm”) and stratified according to sex using permuted blocks. All participants completed a 15-min chest compression training session, and their compression skills were individually evaluated immediately and at 6 months after the training using the Laerdal® PC SkillReporting System at Kyoto University. The primary outcome was the median compression depth during the 2-min test period 6 months after the training. Results: Seventy-two participants were enrolled; 33 participants in each group completed the study. The unlimited group performed significantly deeper chest compressions (>60 mm) immediately after the training than the limited group; however, there was no significant difference 6 months after training. Although not significant, the number of compressions with the recommended depth (49–59 mm) was higher in the limited group. Importance: These results suggest that simplified instructions that do not mention the upper limit of compression depth may help people perform deeper chest compressions; however, there are concerns about the risks associated with too deep compressions. Considering the situation of out-of-hospital cardiac arrest in Japan, studies focusing on compression depths in another aged people should be considered.

Abstract 300: End-Tidal CO 2 -Guided Chest Compression Delivery Improves Survival in a Pediatric Model of Respiratory Failure and Cardiac Arrest

Introduction: The American Heart Association (AHA) recommends the use of end-tidal CO 2 (ETCO 2 ) to evaluate the quality of chest compression delivery during CPR. In a pediatric model of asphyxial cardiac arrest, ETCO 2 -guided chest compression delivery improved survival over standard CPR. Since the most common cause of pediatric cardiac arrest is respiratory failure, we investigated whether this observed survival benefit persisted in a model of respiratory failure preceding cardiac arrest. Methods: Prior to a 17-min asphyxial cardiac arrest, peak inspiratory pressures were adjusted to a goal PaCO 2 of 80 torr to mimic pre-arrest respiratory failure. Male swine (3-4 kg) were randomized to receive either ETCO 2 -guided or standard CPR for 10 min of BLS followed by 10 min of ALS. In the ETCO 2 -guided group, chest compression rate and depth were adjusted to obtain a maximal ETCO 2 level. In the standard group, chest compressions were delivered per AHA guidelines. Hemodynamic parameters were recorded every 30 seconds, and resuscitation was continued for 20 min or until ROSC. Results: Twenty swine underwent asphyxial cardiac arrest. After adjustment of ventilation prior to asphyxia, pH and PaCO 2 were 7.15 and 79 torr in the ETCO 2 -guided group and 7.14 and 78 torr in the standard group. Survival was greater in the ETCO 2 -guided group than in the standard group (7/10 versus 1/10; p=0.02). During resuscitation, mean ETCO 2 and chest compression rate were higher in the ETCO 2 -guided group (38.6 ± 1.2 versus 22.9 ± 1.2, p=0.01; 154.4 ± 1.2 versus 100.5 ± 0.1, p&lt;0.001, respectively). During resuscitation, diastolic blood pressure, myocardial perfusion pressure, systemic perfusion pressure, and cerebral perfusion pressure were higher in the ETCO 2 -guided group ( Figure 1 ) Conclusions: ETCO 2 -guided chest compression delivery improves survival and resuscitation hemodynamics over standard CPR in a pediatric model of respiratory failure and cardiac arrest.

Homing in on Optimal Compression Rate and Depth for CPR

Adult cardiac arrest guidelines recommend delivery of chest compressions at a rate of 100 to 120 per minute and a depth of 5 to 6 cm. This guidance is

The Effect of Asphyxia Arrest Duration on a Pediatric End-Tidal CO2-Guided Chest Compression Delivery Model.

To determine the effect of the duration of asphyxial arrest on the survival benefit previously seen with end-tidal CO2-guided chest compression delivery. Preclinical randomized controlled study. University animal research laboratory. Two-week-old swine. After either 17 or 23 minutes of asphyxial arrest, animals were randomized to standard cardiopulmonary resuscitation or end-tidal CO2-guided chest compression delivery. Standard cardiopulmonary resuscitation was optimized by marker, monitor, and verbal feedback about compression rate, depth, and release. End-tidal CO2-guided delivery used adjustments to chest compression rate and depth to maximize end-tidal CO2 level without other feedback. Cardiopulmonary resuscitation for both groups proceeded from 10 minutes of basic life support to 10 minutes of advanced life support or return of spontaneous circulation. After 17 minutes of asphyxial arrest, mean end-tidal CO2 during 10 minutes of cardiopulmonary resuscitation was 18 ± 9 torr in the standard group and 33 ± 15 torr in the end-tidal CO2 group (p = 0.004). The rate of return of spontaneous circulation was three of 14 (21%) in the standard group rate and nine of 14 (64%) in the end-tidal CO2 group (p = 0.05). After a 23-minute asphyxial arrest, neither end-tidal CO2 values (20 vs 26) nor return of spontaneous circulation rate (3/14 vs 1/14) differed between the standard and end-tidal CO2-guided groups. Our previously observed survival benefit of end-tidal CO2-guided chest compression delivery after 20 minutes of asphyxial arrest was confirmed after 17 minutes of asphyxial arrest. The poor survival after 23 minutes of asphyxia shows that the benefit of end-tidal CO2-guided chest compression delivery is limited by severe asphyxia duration.

Awareness of CPR-induced consciousness by UK paramedics.

Objectives:Guidelines for the management of hospital cardiac arrest advocate minimally interrupted chest compressions in order to maintain cerebral perfusion pressures and improve the likelihood of a positive outcome. One condition that may lead to interruptions in the delivery of chest compressions is cardiopulmonary resuscitation induced consciousness (CPR-IC). This study investigates UK paramedics’ understanding of CPR-IC and how they came by their knowledge.Methods:This study was a cross-sectional survey of paramedics who were registered with the Health and Care Professions Council (HCPC) and practising in the United Kingdom at the time of the survey. Participants completed an online survey; the first two sections are reported here. Section 1 asked for demographic data pertinent to the study outcomes and section 2 asked participants to explain what they understood about CPR-IC and the source of their information.Results:A total of 293 eligible participants completed the survey. Most had over 5 years’ experience as a paramedic and declared no specialist clinical role. Over 50% of respondents said that they had heard of CPR-IC prior to the study and the majority of those provided an explanation that demonstrated some understanding when compared with the definition used by the study team. Over 40% of respondents became aware of CPR-IC after having witnessed it in clinical practice.Conclusion:Nearly half of the study participants were not aware of CPR-IC, and few have had formal training on the phenomenon. There is a clear need for further education on CPR-IC in order for paramedics to better manage it when presented with it in practice.

Teaching Cardiopulmonary Resuscitation to Young Children (

Out-of-hospital cardiac arrest is a major public health concern. Research has shown that initiation of cardiopulmonary resuscitation (CPR) by lay bystanders increases survival rates. Evidence also shows that CPR training, delivered in various ways, is successful in a wide age range of children. This study was conducted to assess if children (average age of 12) were able to perform high quality chest compressions and whether this can be achieved by supplementing CPR instructional video with other methods to time delivery of compressions. A total of 160 study subjects were divided into 3 groups. The CPR instructional video was played for all 3 groups. One group (n = 53) was instructed to time their compressions with a popular music. Another group (n = 56) was assigned to a specially designed video game whereby they practiced how to time chest compressions. The control group (n = 51) consisted of those who only watched the video. Each group was divided in teams of 3 and observed for successful delivery of chest compressions on the little Anne Adult CPR training manikins. The control group performed a mean of 88 compressions per minute (CPM) out of which a mean of 72 clicks were appreciated. The music group performed 104 CPM with 74 clicks. Meanwhile, the video game group performed 102 CPM with 78 clicks. This study demonstrated sixth graders are capable of learning and performing effective hands only bystander CPR and this can and should be taught in schools even as young as the sixth grade level.

Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest-the PERSEUS resuscitation protocol.

Resuscitation guidelines remain uniform across all cardiac arrest patients, focusing on the delivery of chest compressions to a standardized rate and depth and algorithmic vasopressor dosing. However, individualizing resuscitation to the appropriate hemodynamic and ventilatory goals rather than a standard "one-size-fits-all" treatment seems a promising new therapeutic strategy. In this article, we present a new physiology-guided treatment strategy to titrate the resuscitation efforts to patient's physiologic response after cardiac arrest. This approach can be applied during resuscitation attempts in highly monitored patients, such as those in the operating room or the intensive care unit, and could serve as a method for improving tissue perfusion and oxygenation while decreasing post-resuscitation adverse effects.

Abstract 151: Do the Simplified 2015 ERC Guidelines Improve Basic Life Support Performance Compared to 2010 ERC Guidelines?

Background: The European Resuscitation Council (ERC) 2015 basic life support (BLS) algorithm has been simplified compared with the ERC 2010 BLS algorithm. Simplification of resuscitation guidelines may facilitate learning and improve guidelines adherence. This study aimed to study BLS performance using ERC 2015 compared with ERC 2010 guidelines. Methods: This is an observational study including video recordings of laypersons being skill tested after participation in a standardized ERC BLS/AED course using either the simplified ERC 2015 or ERC 2010 guidelines. The endpoints were 1) performing all steps of the BLS/AED algorithm correctly, 2) remembering the sequence of actions of the BLS/AED algorithm, 3) time to emergency medical service call, 4) time to first chest compression and 5) time to first shock. Results: We analyzed videos of 100 laypersons (50 trained using the simplified 2015 guidelines and 50 trained using the 2010 guidelines). Overall, 78% and 62% correctly performed all of the steps of the 2015 and 2010 guidelines respectively (p=0.08), whereas 94% and 82% remembered the correct sequence of actions of the 2015 and 2010 algorithms, respectively (p=0.06). There was no significant difference between participants following the 2015 vs 2010 algorithms with respect to time to emergency medical service call (difference: 0 sec, (95% confidence interval (CI): -3; 2) P=0.70), time to first chest compression (difference: 0 sec, (95% CI: -3;3) P=1.00), and time to first shock (difference: 0 sec, (95% CI: -6; 7) P=0.90). Conclusion: Laypersons tends to better perform resuscitation and adhere to the BLS algorithm when using the simplified ERC 2015 guidelines compared to the 2010 Guidelines. There were however no differences in time to emergency medical service call, time to first chest compression and shock delivery.

Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest

BackgroundThe American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end‐tidal carbon dioxide (ETCO 2) or diastolic blood pressure (DBP) levels were used to guide chest compression delivery after asphyxial cardiac arrest.Methods and ResultsOne‐ to 2‐week‐old swine underwent a 17‐minute asphyxial‐fibrillatory cardiac arrest followed by alternating 2‐minute periods of ETCO 2‐guided and DBP‐guided chest compressions during 10 minutes of basic life support and 10 minutes of advanced life support. Ten animals underwent resuscitation. We found significant changes to ETCO 2 and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO 2 level was greater during ETCO 2‐guided cardiopulmonary resuscitation (26.4±5.6 versus 22.5±5.2 mm Hg; P=0.003), whereas the overall mean DBP was greater during DBP‐guided cardiopulmonary resuscitation (13.9±2.3 versus 9.4±2.6 mm Hg; P=0.003). ETCO 2‐guided chest compressions resulted in a faster compression rate (149±3 versus 120±5 compressions/min; P=0.0001) and a higher intracranial pressure (21.7±2.3 versus 16.0±1.1 mm Hg; P=0.002). DBP‐guided chest compressions were associated with a higher myocardial perfusion pressure (6.0±2.8 versus 2.4±3.2; P=0.02) and cerebral perfusion pressure (9.0±3.0 versus 5.5±4.3; P=0.047).ConclusionsUsing the ETCO 2 or DBP level to optimize chest compression delivery results in physiologic changes that are method‐specific and occur within 30 s. Additional studies are needed to develop protocols for the use of these potentially conflicting physiologic targets to improve outcomes of prolonged cardiopulmonary resuscitation.

Intramural atrial hematoma complicating transesophageal echocardiography during cardiac arrest

BackgroundAdequate strategies using either transthoracic (TTE) or transesophageal (TEE) echocardiography in patients receiving cardiopulmonary resuscitation (CPR) is an ongoing area of research. ObjectivesAs transthoracic point-of-care ultrasound (POCUS) during cardiac arrest resuscitation might result in an increased duration of interruptions in the delivery of chest compressions; the use of TEE has been proposed as an alternative. MethodsNo technical complications of either TTE nor TEE are so far being reported in the literature. ResultsWe report the case of a left intramural atrial hematoma complicating TEE procedure during cardiac arrest. This highlights a unique and to our knowledge, first-in-man, described complicating TEE procedure during CPR. ConclusionsFurther research on the safety of transesophageal echo during CRP is mandatory and the question about any potential harm of particular interest.