European Resuscitation Council Guidelines Research Articles

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study.

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Voluntary first responders’ experiences of being dispatched to suspected out-of-hospital cardiac arrest in rural areas: an interview study

BackgroundOut-of-hospital cardiac arrest (OHCA) is a leading cause of death, and survival outcomes vary across countries and regions. To improve survival, the European Resuscitation Council Guidelines encourage the implementation of technologies like smartphone applications to alert voluntary first responders (VFRs) who are near a suspected OHCA. VFRs are of great importance in the ´chain of survival´, but there is still a lack of knowledge about their experiences; especially of those operating in rural areas. Understanding those experiences is crucial in developing appropriate interventions to train, encourage, and safeguard VFRs in their mission. Therefore, the aim of this study was to describe VFRs´ experiences of being dispatched to suspected OHCA in rural areas.MethodsThe study used an inductive design. The data were collected using individual interviews with 16 VFRs and analysed using qualitative content analysis.ResultsThe results are presented in terms of six generic categories ‘‘Being motivated and prepared’’, ‘‘Having strategies to undertake the mission’’, ‘‘Collaborating with others’’, ‘‘Being ethically aware’’, ‘‘Supporting the family members’’, and ‘‘Coping with the mission’’, which formed the basis of the main category ‘Desire to save lives and help others’. The findings showed that VFRs had a genuine desire to contribute to save lives in this rural area. Regardless of the circumstances, they were prepared to leave everything and act to the best for the victim and their family members. In theirs’ missions they collaborated with others at the scene and were guided by ethics while they acted in complex circumstances.ConclusionsVFRs dispatched in rural areas express a desire to save lives. In their missions, they acted in complex situations and experienced both emotional and ethical challenges.The design, implementation, and evaluation of support interventions directed at VFRs should be prioritised, especially in rural areas, as it can contribute to more people becoming and remaining VFRs, which in turn could contribute to sustainable development.

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

AimBag-mask ventilation (BMV) is often applied during advanced cardiopulmonary resuscitation (CPR). Lay rescuers usually apply mouth-to-mouth ventilation, which is contraindicated in case of potential disease transmission (e.g., during the COVID-19 pandemic). This study evaluates the influence of rescuers' before BMV training in following the correct BMV procedures during adult and infant CPR.MethodsMedical students (n = 112) were enrolled in a randomized cross-over manikin study: 60 first-year students (53.6%) (untrained, without any prior knowledge of CPR) and 52 fourth-year students (46.4%) (BLS-trained, with three consecutive years of basic CPR training), excluding Basic Life Support (BLS) certificate holders or lifeguards. Student-formed duos (i.e., two students from the same year working together) received a 15-min just-in-time onsite training in full CPR cycle using BMV and were tested during five cycles of 2-person CPR following the European Resuscitation Council (ERC) guidelines with the inclusion of BMV. Tidal volumes of 300–600 ml (adults) and 20–60 ml (infants) were considered as correct ventilations.ResultsFrom the initial 56 duos, 17 (30.4%) were excluded after applying incorrect numbers of ventilation or uninterpretable values. In adult CPR, comparing BLS-trained rescuers to untrained ones in correctly administrating ventilations using BMV after a 15-min just-in-time onsite training revealed no statistically significant difference [first years: 63.0% (n = 136 out of 216 ventilations); fourth years: 59.5% (n = 119 out of 200 ventilations); with a proportional difference of −3.5% (−12.8; 5.9)]. In infant CPR, a significant difference was observed in effective ventilations [first years: 55.5% (n = 120 out of 216 ventilations); fourth years: 72.3% (n = 133 out of 184 ventilations); with a proportional difference of 16.8 (7.25; 26.21)].ConclusionTwo-person BMV is a complex skill to perform both in adults and children, requiring sufficient and regular training. Lay rescuers receiving a 15-min just-in-time onsite BMV training could perform decent BMV in an adult CPR setting. BMV during infant CPR requires more extensive prior training and should not be entrusted to lay rescuers, even after a 15-min just-in-time onsite training.

344 Shout for help: Still part of adult basic life support education, but not recommended by European resuscitation council guidelines

344 Shout for help: Still part of adult basic life support education, but not recommended by European resuscitation council guidelines

Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery.

Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines. The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy. Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.

Early NSE measurements at the ICU bear prognostic value in patients with and without CPR

Abstract Funding Acknowledgements Type of funding sources: None. Background Neuron-specific enolase (NSE) represents a diagnostic tool for identifying poor neurological outcomes in patients following CPR. As part of multimodal prognostication, NSE values above 60 µg/L after 48h and/or 72h were associated with a worse neurologic outcome (European Resuscitation Council Guidelines 2021). Despite the prognostic value of NSE 48h to 72h after CPR, measurements at admission to the ICU remain the topic of discussion as divergent findings are present in the literature (primarily in small collectives). Purpose Within the proposed study, we aimed to illuminate the prognostic value of NSE measurements on the day of admission to the ICU. Furthermore, we conducted a comparison of patients with and without CPR prior to ICU admission. Due to hemolysis sensitivity, we adjusted NSE values according to a previously published protocol to reveal potential changes in predictive potential through the occurrence of hemolysis. Methods This was a prospective, observational cohort study. 232 consecutive patients admitted to a cardiac ICU were screened over the course of one year. Patients with active malignancies or traumatic brain injuries were excluded. Furthermore, samples with hemolysis index >30 units were excluded to guarantee stable measurements. NSE values were measured on the day of admission to the ICU in a total of 202 patients (154 without previous CPR, 48 with CPR) using specific ELISA kits. According to an earlier publication, hemolysis was considered to account for an artificial increase of 0.29µg/L per unit (range 5-30 units) and was subsequently subtracted. Results Median age was 66.96 (IQR: 55.7-76.9), and 41.1% of the included patients were female. The total 30-day-mortality was calculated to be 27.2%, and 48 patients (23.8%) were admitted following CPR. Interestingly NSE at admission was not higher in patients after CPR (3.23 ± 3.88 µg/L vs 5.43 ± 5.78 µg/L, p = 0.072). However, NSE measurements on the day of admission were significantly elevated in 30-day none-survivors (3.23 ± 3.84 µg/L vs 6.91 ± 6.55 µg/L, p < 0.001). The same findings were made when excluding all patients after CPR (30-day survivors: 3.24 ± 3.99 µg/L vs 30-day none-survivors: 6.15 ± 6.17µg/L, p = 0.001). No statistically significant differences in survival were found when stratifying for the primary cause of admission. Comparing hemolysis-corrected NSE values to raw data showed a slight increase in positive predictive value for 30-day mortality in the total cohort (ROC-AUC: 0.732 vs 0.721) as well as in patients without prior CPR (ROC-AUC: 0.722 vs 0.703). Conclusion We provided evidence for the prognostic value of early NSE measurements at the ICU. In both the total cohort as well as a sub-cohort without patients admitted after CPR, 30-day none-survivors displayed markedly elevated levels of NSE. Moreover, the positive predictive value of these measurements was slightly increased when correcting for hemolysis >5 units.

Impact of the 2015 European guidelines for resuscitation on traumatic cardiac arrest outcomes and prehospital management: A French nationwide interrupted time-series analysis

AimTo evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on patient outcomes following traumatic cardiac arrest (TCA) and on advanced life support interventions carried out by physician-staffed ambulances. MethodsData of TCA patients aged ≥18 years were extracted from the French nationwide cardiac arrest registry. A pre- (2011–2015) and a post-publication period (2016–2020) were defined. In the guidelines, a specific TCA management algorithm was introduced to prioritise the treatment of reversible causes. Its impact was evaluated using adjusted interrupted time series analysis. Results4,980 patients were treated (2,145 during the pre-publication period and 2,739 during the post-publication period). There was no significant change in the rates of prehospital ROSC (22.4% vs. 20.2%, p = 0.07 in the pre- and post- intervention respectively), survival (1.4% vs. 1.4%, p = 0.87) or good neurological outcome (71.4% vs. 66.7%, p = 0.93) or in the incidence of organ donation (1.6% vs. 1.3%, p = 0.50). There were nonsignificant changes in the adjusted temporal trend for ROSC (aOR 0.88; 95% CI [0.77; 1.00]), survival (aOR 1.34; 95% CI [0.83;2.17]), good neurological outcome (aOR 1.57; 95% CI [0.82;3.05]), and organ donation (aOR 1.06; 95% CI [0.71;1.60]). The use of intraosseous catheters (13.0% vs. 19.2%, p < 0.001), external haemorrhage control measures (23.9% vs. 64.8%, p < 0.001), bilateral chest decompression (13.7% vs. 16.5%, p = 0.009), and packed red cell transfusion (2.7% vs. 6.5%, p < 0.001) increased in the post-publication period. ConclusionsDespite the increased frequency of trauma rescue interventions performed by on-scene physicians, no change in patient-centred outcomes was associated with the publication of the 2015 ERC guidelines in France.

Survey on currently applied interventions in neonatal resuscitation (SCIN): A study protocol.

Around 140 million children are born every year and post-natal transition is uncomplicated in the vast majority. However, around 5%-15% of neonates receive supportive interventions during transition. Recent data on the interventions used is scarce. More data on the frequencies with which these interventions are used is needed to evaluate neonatal resuscitation, guide recommendations and to generate hypotheses for further research. The following protocol describes an international, multicentre survey on the interventions currently applied during neonatal resuscitation. To determine the frequencies at which different supportive interventions recommended by European Resuscitation Council (ERC) guidelines for neonatal resuscitation are used. To compare the frequencies between hospitals and patient groups and to investigate possible factors influencing any differences found. Participating hospitals will collect data on all interventions performed during neonatal resuscitation over a period of 6 months. All hospitals providing perinatal care are eligible regardless of size and designated level of neonatal care. Every neonate requiring more interventions than basic drying and tactile stimulation during the first 30 min of life will be included. The targeted sample size is at least 4,000 neonates who receive interventions. After anonymization, the data is pooled in a common database and descriptive and statistical analysis is performed globally and in subgroups. Possible correlations will be investigated with phi coefficient and chi square testing. Consent of the institutional review board of the Technical University Dresden was obtained for the local data collection under the number BO-EK-198042022. Additionally, approval of local ethical or institutional review boards will be obtained by the participating hospitals if required. Results will be published in peer-reviewed journals and presented at suitable scientific conferences.

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).

What matters and influence resuscitation preference? Development, field testing, and structural validation of items among older patients in the emergency department

BackgroundDecisions about resuscitation preference is an essential part of patient-centered care but a prerequisite is having an idea about which questions to ask and understand how such questions may be clustered in dimensions. The European Resuscitation Council Guidelines 2021 encourages resuscitation shared decision making in emergency care treatment plans and needs and experiences of people approaching end-of-life have been characterized within the physical, psychological, social, and spiritual dimensions. We aimed to develop, test, and validate the dimensionality of items that may influence resuscitation preference in older Emergency Department (ED) patients.MethodsA 36-item questionnaire was designed based on qualitative interviews exploring what matters and what may influence resuscitation preference and existing literature. Items were organized in physical, psychological, social, and spiritual dimensions. Initial pilot-testing to assess content validity included ten older community-dwelling persons. Field-testing, confirmatory factor analysis and post-hoc bifactor analysis was performed on 269 older ED patients. Several model fit indexes and reliability coefficients (explained common variance (ECV) and omega values) were computed to evaluate structural validity, dimensionality, and model-based reliability.ResultsItems were reduced from 36 to 26 in field testing. Items concerning religious beliefs from the spiritual dimension were misunderstood and deemed unimportant by older ED patients. Remaining items concerned physical functioning in daily living, coping, self-control in life, optimism, overall mood, quality of life and social participation in life. Confirmatory factor analysis displayed poor fit, whereas post-hoc bifactor analysis displayed satisfactory goodness of fit (χ2 =562.335 (p<0.001); root mean square error of approximation=0.063 (90% CI [0.055;0.070])). The self-assessed independence may be the bifactor explaining what matters to older ED patients’ resuscitation preference.ConclusionsWe developed a questionnaire and investigated the dimensionality of what matters and may influence resuscitation preference among older ED patients. We could not confirm a spiritual dimension. Also, in bifactor analysis the expected dimensions were overruled by an overall explanatory general factor suggesting independence to be of particular importance for clinicians practicing resuscitation discussions in EDs. Studies to investigate how independence may relate to patients’ choice of resuscitation preference are needed.

Five vs. two initial rescue breaths during infant basic life support: A manikin study using bag-mask-ventilation.

Children are more likely to suffer a hypoxic-ischaemic cause for cardiac arrest. Early ventilation may provide an advantage in outcome during paediatric cardiopulmonary resuscitation [CPR]. European Resuscitation Council guidelines recommend five initial rescue breaths [IRB] in infants, stemming from the hypothesis that rescuers might need 5 attempts in order to deliver 2 effective ventilations. This study aimed to verify this hypothesis. Participants (n = 112, convenience sample) were medical students from the Faculty of Medicine and Health Sciences Ghent University, Belgium. Students were divided into duos and received a 15 min just-in-time training regarding the full CPR-cycle using BMV. Participants then performed five cycles of 2-person CPR. The IRB were given by 1-person BMV, as opposed to a 2-persons technique during the further CPR-cycle. Correct ventilations for the infant were defined as tidal volumes measured (Laerdal® Q-CPR) between 20 and 60 ml, with n = 94 participants included in the analysis. The primary outcome consisted of the difference in the % of medical student duos providing at least 2 effective IRB between 2 and 5 attempts. Off all duos, 55,3% provided correct volumes during their first 2 initial ventilations. An increase up to 72,4% was noticed when allowing 5 ventilations. The proportional difference between 2 and 5 IRB allowed was thus significant [17,0%, 95% confidence interval (5.4; 28.0)]. In this manikin study, 5 IRB attempts during infant CPR with BMV increased the success rate in delivering 2 effective ventilations. Besides, students received training emphasizing the need for 5 initial rescue breaths. This study provides evidence supporting European Resuscitation Council guidelines.

Ethical aspects of mechanical resuscitation in achild : Results of an expert workshop within the BMBF project CLAIRE-Children's Automated Intelligent Resuscitation

While the use of mechanical resuscitation devices can be considered for adult resuscitation, the European Resuscitation Council guidelines do not yet mention their use for pediatric resuscitation. Only one device has been partially approved for use in children; further pediatric appliances are currently being used off-label. Ethical considerations arising from the use of mechanical resuscitation devices have not yet been presented in astructured way. To elaborate ethical considerations in the development phase of mechanical resuscitation devices for children. Based on several fictitious case reports, an interdisciplinary expert focus group discussion was conducted. This was followed by amoderated discussion, summarizing the results. Guiding principles and research desiderata were formulated using these results as well as existing literature. According to the group of experts, ethical considerations regarding mechanical resuscitation devices in pediatrics predominantly concern the subject of indication and discontinuation criteria. Ethical aspects concerning psychosocial impacts on affected families and intervention teams cannot be generalized and need to be analyzed on acase-by-case basis. The considerations presented regarding the use of mechanical resuscitation devices in the pediatric context, which is still in its developmental stage, could also have practical implications for adult out-of-hospital resuscitation decisions. Concerning ethical aspects of out-of-hospital resuscitation decisions, especially using mechanical resuscitation devices, the need for accompanying empirical research is substantial.

Development of the epidemiology and outcomes of out-of-hospital cardiac arrest using data from the German Resuscitation Register over a 15-year period (EpiCPR study)

BackgroundSudden cardiac arrest is a relevant problem with a significant number of deaths in Europe. AimUsing data from the German Resuscitation Register (GRR), we examined changes in epidemiology and therapeutic interventions over a 15-year period in order to identify key factors contributing to favourable outcome in out-of-hospital cardiac arrest (OHCA) patients. MethodsGRR data were analysed in 5-year periods (2006–2010 vs 2011–2015 vs 2016–2020) representing changes in the European Resuscitation Council (ERC) guidelines. Group comparison of OHCA patients was made for epidemiological and resuscitation-associated factors. Endpoints included 30-day survival and hospital discharge with a good neurological outcome (CPC 1,2). Matched-pair analysis compared outcomes, and multivariate binary logistic regression analysis identified variables with effects on survival. ResultsA total of 42,997 GRR patients were studied (2006–2010: n = 3,471, 2011–2015: n = 16,122, 2016–2020: n = 23,404). Proportion of patients over 80 years, use of intraosseous (IO) access and supraglottic airway devices, rate of bystander CPR, and the proportion of telephone CPR increased over the study period. The 30-day survival, and hospital discharge rates with CPC1/2 were unchanged. After adjusting cohorts using matched pairs, a higher CPC1,2 rate was observed (8.8 vs 10.2%, p < 0.03). Logistic regression analysis showed that IO and SAD had an unfavourable impact on outcome. ConclusionDespite a significant increase in bystander and telephone CPR rates, no improvement in 30-day survival and hospital discharge rate with CPC1,2 was observed. Initial rhythm (VF/VT), cardiac and hypoxic cause of CA, bystander CPR and IV access were identified as factors associated with a favourable neurological outcome.

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.

Intracoronary epinephrine during cardiac resuscitation for patients undergoing percutaneous coronary intervention for acute myocardial infarction (iCPR study)

Abstract Background Despite significant progress in cardiopulmonary resuscitation (CPR), outcomes remain relatively poor. Epinephrine administration remains a cornerstone in the treatment of in-hospital cardiac arrest. Various routes of administration, including intravenous, intramuscular, intraosseous and endotracheal routes have been studied; however, the optimal route is debated. Purpose The purpose of this study was to compare patient outcomes following peripheral intravenous (IV), central IV, or arterial intracoronary (IC) epinephrine administration in patients undergoing CPR in the catheterization laboratory. Methods This was a prospective two-center pilot cohort study conducted in high-volume percutaneous coronary intervention (PCI) facilities in the republic of Lithuania. The study enrolled patients with acute myocardial infarction (AMI) who suffered a cardiac arrest in the cardiac catheterization laboratory during PCI. Cardiac resuscitation was performed according to the European Resuscitation Council Guidelines. Central IV was the first choice for epinephrine administration if it was available. However, in cases without central access, the route of epinephrine administration (peripheral IV or arterial IC) was at the discretion of the physician. The primary endpoint was the rate of return of spontaneous circulation (ROSC). We tested for overall differences in patient characteristics and outcomes between groups using Chi-Square (or Kruskal-Wallis) tests and used the Holm-Bonferroni adjustment (or Dunn's tests) for subsequent pairwise tests. We also performed logistic regression. Results There were 158 participants in this study, with 48 (30.4%), 50 (31.6%), and 60 (38.0%) receiving epinephrine via central IV, IC, and peripheral IV routes, respectively. The median age was 71 [61, 80] years and 56% of participants were men. Patient characteristics were similar across routes, except for age (higher for peripheral IV than IC), serum potassium (although no significant post-hoc differences), hemoglobin (lowest in peripheral route), and heart rhythm before CPR (higher rates of electromechanical dissociation in peripheral route). There were 111 (70%) patients who achieved the primary outcome of ROSC (Table 1). Peripheral IV administration was associated with 7-fold decreased odds of achieving ROSC (odds ratio = 0.14, 95% confidence interval = 0.05–0.36, p&amp;lt;0.0001) compared to central IV (no difference between central IV and IC; p=0.9343). By itself, adrenaline route yielded an area under the receiver operating characteristic curve of 0.73, indicating good predictive ability. Conclusion Epinephrine administration route was a significant predictor of ROSC for patients with AMI undergoing CPR in the catheterization laboratory. ROSC rates for patients who received epinephrine via IC or central IV were superior to those who received it via peripheral IV. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Baylor Health Care System Foundation (USA)National Interventional Cardiology Association (Lithuania)

Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries

BackgroundOut-of-hospital cardiac arrest (OHCA) due to trauma is rare, and survival in this group is infrequent. Over the last decades, several new procedures have been implemented to increase survival, and a “Special circumstances chapter” was included in the European Resuscitation Council (ERC) guidelines in 2015. This article analysed outcomes after traumatic cardiac arrest in Germany using data from the German Resuscitation Registry (GRR) and the TraumaRegister DGU® (TR-DGU) of the German Trauma Society. MethodsIn this study, data from patients with OHCA between 01.01.2014 and 31.12.2019 secondary to major trauma and where cardiopulmonary resuscitation (CPR) was started were eligible for inclusion. Endpoints were return of spontaneous circulation (ROSC), hospital admission with ROSC and survival to hospital discharge.Results1.049 patients were eligible for inclusion. ROSC was achieved in 28.7% of the patients, 240 patients (22.9%) were admitted to hospital with ROSC and 147 (14.0%) with ongoing CPR. 643 (67.8%) patients were declared dead on scene. Of all patients resuscitated after traumatic OHCA, 27.3% (259) died in hospital. The overall mortality was 95.0% and 5.0% survived to hospital discharge (47). In a multivariate logistic regression analysis; age, sex, injury severity score (ISS), head injury, found in cardiac arrest, shock on admission, blood transfusion, CPR in emergency room (ER), emergency surgery and initial electrocardiogram (ECG), were independent predictors of mortality.ConclusionTraumatic cardiac arrest was an infrequent event with low overall survival. The mortality has remained unchanged over the last decades in Germany. Additional efforts are necessary to identify reversible cardiac arrest causes and provide targeted trauma resuscitation on scene.Trial registrationDRKS, DRKS-ID DRKS00027944. Retrospectively registered 03/02/2022.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Trauma associated with cardiopulmonary resuscitation based on autopsy reports after the 2015 ERC guidelines

IntroductionCardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established. AimTo describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries. MethodsThis multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS). ResultsAmong 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS–low risk of fatal injury. ConclusionCPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.

Assessment of Human Factors After Advanced Life Support Courses Comparing Simulated Team and Real Team Assessment: A Randomized Controlled Cohort Trial.

AimHuman factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.MethodsAll 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).ResultsA total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.ConclusionSummative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.

Translated article] Safety in Dermatologic Procedures: Basic and Advanced Cardiopulmonary Resuscitation

This article in the series on safety in dermatologic procedures covers the delivery of basic cardiopulmonary resuscitation (using no devices), instrumental resuscitation (using an automated external defibrillator), and pharmacological resuscitation (using adrenaline). We provide a brief overview of the updated 2021 European Resuscitation Council guidelines and offer an algorithm and visual aids to support recommended practices.