European Resuscitation Council Research Articles

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.

Degree of implementation of structured answering of emergency calls in German emergency dispatch centers and effects of the introduction in daily practice

The emergency call-taking process is crucial for the adequate disposition of emergency vehicles and the provision of first aid instructions. Moreover, it has adirect impact on the quality of out-of-hospital emergency care. Organizations such as the European Resuscitation Council, the German Federal Association of Emergency Medical Directors and the German Association of Emergency Dispatch Centers call for the nationwide implementation of aformal call-taking process in emergency dispatching. This is required for the provision of telephone-assisted cardiopulmonary resuscitation (T-CPR). This article presents the results of an online survey among members of the German Association of Emergency Dispatch Centers on the implementation of structured call-taking programs. The survey comprised data on the implementation of astructured call-taking process, its effects on important quality indicators such as the frequency of T‑CPR and employee satisfaction. Of the 100 participants who completed the survey, 49 already used formal call-taking systems and 24 (47%) of the remaining 51emergency dispatch centers intended to implement such asystem. Formal call-taking systems were mainly used in the dispatch of emergency medical services (98% of emergency dispatch centers using aformal call-taking system) and fire brigades (83.7% of emergency dispatch centers using aformal call-taking system). In 42 (85.7%) of the 49emergency dispatch centers using aformal call-taking process, this process is mandatory; however, only 27 (64.3%) reported compliance rates of more than 95% in medical emergencies. Comparing the pre-post results after the introduction of astructured approach, the quality of the inquiries improved for almost all emergency dispatch centers. On the other hand, important quality indicators, e.g. mean dispatch initiation time or the necessity of subsequently alerting an advanced life support unit to the scene, were not recorded in 42.9% and 49.0% of the dispatch centers, respectively. Of the emergency dispatch centers that analyzed the frequency of T‑CPR, 94.3% could show an increase in T‑CPR. Moreover, 79.5% of the respondents reported improved employee satisfaction. Whereas the demand for dispatchers remained nearly static, 24 out of the 49dispatch centers that used aformal call-taking system set up new posts for quality management (maximum: 3posts in dispatch centers handling more than 250,000 missions annually). Structured emergency call-taking has not yet been comprehensively implemented in German emergency dispatch centers. Wherever it is used consistently, important quality parameters are improved. Further investigations should aim to identify crucial factors for its implementation and to analyze additional quality parameters.

Neuropsychological care after out-of-hospital cardiac arrest – the CARE clinic model

European Resuscitation Council guidelines recommend screening for cognitive and emotional problems for all survivors of out-of-hospital cardiac arrest (OHCA), and prompt referral to a psychiatrist, psychologist or neuropsychologist when appropriate. In our specialist cardiac centre we have created the first care after resuscitation (CARE) clinic to offer cardiac arrest survivors and their carers psychological, cognitive and medical support up to 1 year after discharge from hospital. In our specialist centre, we see in excess of 70 OHCA survivors a year. …

Local medical students can be instructors for life-saving first-aid courses for lay people: a descriptive study from Gaza

BackgroundBystanders can initiate a chain of survival in emergency situations by recognising the situation, calling for help, and initiating basic life support (BLS) and first aid. The lay population of Gaza has had little if any access to systematic BLS and CPR training. This study aimed to find out whether medical students could act as instructors to train 3000 lay people in BLS and CPR. MethodsWe selected 82 medical students from Al Azhar University to train as BLS and CPR instructors. Student volunteers who were in their third, fifth, and sixth year of medical school were chosen based on sex (to achieve equal numbers of males and females) and geography (for approximately even geographical distribution). Their training included 12 hours of BLS and CPR skills and 4 hours of didactic instruction, with a view to delivering 1–2 hours of basic training for lay people. Students responded to a written questionnaire with details of their demographics, training experience, motivation, and expectations. Teaching materials and methods were based on the European Resuscitation Council guidelines and followed a similar training model as that at The Arctic University of Norway (UiT). The board of the Faculty of Medicine at Al Azhar University approved the training and the study. Findings82 medical students completed training (mean age 21·7 years [SD 1·25]; 54% [44 of 82] female, 46% [38 of 82] male). Following training, 87% of students (71 of 82) responded to the questionnaire and 76% (62 of 82) took part in training lay people. Of those who completed the questionnaire, five reported having lost family members during Israeli military operations in Gaza (the questionnaire section on demographics included the impact of warfare on the students' lives). Almost two-thirds (54 of 71) had no previous practical first aid training. 49 of 71 (69%) described a sense of belonging and duty to the community as their most important motivation, and 56 of 71 (79%) hoped that their training would contribute to increased capacity and skills in the community's response to emergencies, especially during attacks. 55 training sessions have been completed so far, involving 1222 lay participants, mostly school students (including students at vocational schools) aged 13–20 years (75%; 922 of 1222). 62 student instructors have been active, with a ratio of 5·4 lay trainees to each student instructor. Of the trainees, 45% were male (546 of 1222) and 55 % female (676 of 1222). InterpretationWe have shown that local medical students are willing and capable of being trained as volunteer instructors to teach BLS and CPR, targeting lay people in serious conditions. The effects of such training on local resilience and patient outcomes need further study. FundingThe Palestine Children Relief (PCRF) funded the travel expenses of the trainers and provided medical students with first aid kits.

Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol.

More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. The evaluation included resuscitation guidelines and 22 studies identified through a MEDLINE search. Evidence-based resuscitation differs from advanced cardiovascular life support guidelines. European Resuscitation Council guidelines include correcting reversible causes of arrest, applying defibrillation/pacing before external cardiopulmonary resuscitation, resternotomy within 5 minutes if electrical therapies fail, and restricting epinephrine use to avoid rebound hypertension. A 2017 Society of Thoracic Surgeons protocol derived from European Resuscitation Council guidelines is now standard of care in the United States. Evidence-based practices can improve survival and reduce resternotomy rates. This article describes the clinical implementation of the Society of Thoracic Surgeons guidelines.

Knowledge and experience of cardiopulmonary resuscitation among cardiologists in clinical practice: A multicenter cross-sectional study.

Objective:This study aimed to investigate the theoretical knowledge and clinical experience of cardiopulmonary resuscitation (CPR) among Turkish cardiologists according to the recommendations of the 2015 European Resuscitation Council (ERC) guidelines.Methods:A total of 120 cardiologists from 14 different medical centers (six university and eight research-education hospitals) in İstanbul were included in the study. The questionnaire consisting of 29 open-ended and multiple choice questions on CPR was used and validated based on the ERC guidelines published in 2015. The percentage of correct answers was calculated for each participant.Results:Of the 120 cardiologists included in this study, 108 (90%) accepted the participation, and the median percentage of correct answers for theoretical questions was 53% (38-72). The percentage of correct answers for interventional cardiologists (48%, n=52) was significantly higher [60% (50–66) vs. 46% (38-52), p<0.001]. Regarding the type of medical centers, no statictical difference was found in terms of theoretical knowledge on CPR [57% (50-72) university hospitals vs. 49% (41-57) research-education hospitals, p=0.160). Peri-arrest transthoracic echocardiography was used in 71% of cases. The ratio of participants who had received an advanced cardiac life support course in the preceding year was only 19% (n=20), and those participants had a significantly higher score regarding the CPR theoretical knowledge questions [68% (54-70) vs. 46% (38-51), p<0.001].Conclusion:The theoretical knowledge of cardiologists on CPR is not satisfactory according to the 2015 ERC guidelines. An increased frequency of CPR training courses may improve this result.

ABC or CAB sequence in paediatric cardiopulmonary resuscitation?

Quality cardiopulmonary resuscitation is essential for a per­son in cardiac arrest. Survival chances and subsequent qua­lity of life depend on timely quality resuscitation. For over 40 years, in all types of patients, ABC sequence was in­ter­na­tio­nally accepted. Although in-hospital cardiac ar­­rest prognosis has significantly improved in recent years, the survival was lower in out-of-hospital cardiac arrest, especially in infants and children. In an attempt to improve post-cardiac arrest survival, since 2010, based on studies published after 2000, a CAB sequence has been recommended in adults, in order to reduce the time to chest compressions. This is partly sustained by the fact that, in adults, the main cause of cardiac ar­rest is a cardiovascular disease. For resuscitation at birth, the ABC sequence is maintained, but controversy per­sists with respect to approach of cardiac arrest in in­fants and children. The American Heart Association and the American Academy of Pediatrics recommend the use of CAB sequence, for similar reasons as those for adults. The European Resuscitation Council recommends main­tai­ning the traditional ABC sequence, arguing that most of the cases of cardiac arrest in children are caused by a res­pi­ra­tory disease. Pro and counter arguments for the two options are discussed in the paper. For the time being, a practical and logical conclusion would be the use of the ABC sequence in cardiac arrest of respiratory origin and CAB in those of cardiac origin – as long as the cause can be rapidly identified, based on the patient’s status and the context in which cardiac arrest has occurred.

Knowledge, Behaviors, and Attitudes of Polish Nurses As Compared With Evidence-Based Practice in Relation to the Guidelines of the European Resuscitation Council.

BackgroundThe emphasis on Evidence-Based Practice (EBP) is taking on new importance as the profession of nursing strives to meet the challenge of defining the direction of health care, promoting optimal outcomes, and ensuring patient safety. Therefore, Evidence-Based Practice has never been more important to nursing than in the current health-care environment.ObjectiveThe study was designed to assess the knowledge, behaviors, and attitudes of nurses as compared with Evidence-Based Practice in relation to the Guidelines of the European Resuscitation Council.MethodsThe study covered involved a total of 236 nurses who participated in a cardiopulmonary resuscitation course over a period of 12 months. The nurses who qualified for the study followed a complete study registration procedure.ResultsThe current findings show that the lowest score was achieved in the domain of attitude toward selected Evidence-Based Practice aspects in professional work. Detailed domain questions concerned nurses’ Evidence-Based Practice and its limitations related to procedures, the lack of equipment and personnel issues, as well as the lack of scientific evidence. Furthermore, nurses saw clinical experience as being more valuable than research findings for practical decision-making than research findings, and, according to the respondents, they presented opinions that the best way to assess the effectiveness of an action was through clinical experience. In addition, the nurses gave low scores and tended to underestimate the critical literature review aspect within the domain, along with its significance for the general professional practice, believing that search for scientific evidence alone does not apply into their professional work.ConclusionsThe validated Polish version of the Evidence-Based Practice profile questionnaire is a reliable instrument. The study demonstrates that nurses are facing a multitude of limitations due to procedures, the lack of equipment, and personnel issues. Currently perceived as very poor, the ability to make critical assessments and synthesize evidence should be improved. According to the nurses, clinical experience cannot be the only and the best way to assess the effectiveness of a given measure.

Effect of body position on relieve of foreign body from the airway.

Foreign body airway obstruction (FBAO), or commonly known as choking, is an extremely dangerous event. The European Resuscitation Council recommends that back blows and abdominal thrusts should be performed for relieving FBAO in conscious adults. Reviewed here evidence suggests that applying a prone or a head-down position increases effectiveness of the above standard approaches to relieve obstruction, due to help of gravity.

Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery

Dexmedetomidine is an elective alpha-2 adrenergic agonist, being used in anesthesia practice. It offers sedative, anxiolytic, analgesic, muscle relaxant, and sympathetic lytic properties. While respiratory effects are considered minor, there are important cardiovascular side effects with bradycardia and hypotension being the most common. This article presents a case of a patient, with significant comorbidities and polypharmacy, who was scheduled for cataract surgery under dexmedetomidine sedation. During the administration, severe hemodynamic deterioration was observed with bradycardia and hypotension leading to asystole. Cardiac arrest was successfully managed in accordance with the guidelines of the European Resuscitation Council. Despite the promising role of dexmedetomidine in anesthesia practice, the associated adverse effects cannot be ignored. For this reason it is obligatory to have the minimum mandatory monitoring in accordance with the safety and quality guidelines.

Decision-making in cardiac arrest: physicians' and nurses' knowledge and views on terminating resuscitation.

IntroductionMany cardiopulmonary resuscitation (CPR) attempts are unsuccessful and must be terminated. On the contrary, premature termination results in a self-fulfilling prophecy. This study aimed to investigate 1) physicians’ self-assessed competence in terminating CPR, 2) physicians’ and nurses’ knowledge of the European Resuscitation Council guidelines on termination, and 3) single factors leading to termination.MethodsQuestionnaires were distributed at advanced cardiac life support (ACLS) courses at a university hospital in Denmark. Participants included ACLS health care providers, ie, physicians and nurses from cardiac arrest teams, intensive care and anesthetic units or medical wards with a duty to provide ACLS. Physicians were divided into junior physicians (house officers) and experienced physicians (specialist registrars and consultants).ResultsOverall, 308 participants responded (104 physicians and 204 nurses, response rate: 98%). Among physicians, 37 (36%) did not feel competent to decide when to terminate CPR (junior physicians: n=16, 64%, compared with experienced physicians: n=21, 28%, P=0.002). Two (2%) physicians and one (0.5%) nurse were able to state the contents of termination guidelines. Several factors were reported to impact termination, including absence of a pupillary light reflex (physicians: 17%, nurses: 22%) and cardiac standstill on echocardiography (physicians: 18%, nurses: 20%). Moreover, nine (9%) physicians and 35 (17%) nurses would terminate prolonged CPR despite a shockable rhythm present.ConclusionOne-third of all physicians did not feel competent to decide when to terminate CPR. Physicians’ and nurses’ knowledge of termination guidelines was poor, and both professions reported unvalidated or controversial factors as a single reason for terminating CPR.

Wybrane parametry jakości ucisku i relaksacji klatki piersiowej wykonywanej przez personel pielęgniarski w ramach pozaszpitalnego nagłego zatrzymania krążenia ? badanie pilotażowe

Introduction. Sudden cardiac arrest (SCA) in out-of-hospital conditions is a frequent condition of immediate life-emergency of cardiological background. The survival and discharge rate in SCA patients treated by medical services is still at a low level. Aim. The aim of the study was to analyze selected parameters of the quality of chest compressions and relaxation performed by nursing staff as part of out-of-hospital SCA. Material and methods. The study covered a group of 48 nurses working in primary health care in branches of conservative (PRE/C = 24 people, mean age 33.04 ± 9.20) and surgery profile (PRE/I = 24 people, average age 31.88 ± 9.97), participating in the research project of the Center for Medical and Natural Sciences Research and Innovation, University of Rzeszów in Rzeszów. Two months after the initial examination and intervention, the test was repeated. The assessment of selected compression and relaxation parameters was performed using the True CPR Resuscitation Assistant. The statistical analysis of the collected material was carried out with the SPSS Statistics 20 software. The statistical analysis used the analysis of variables using parametric and non-parametric tests. The statistical significance was assumed at p &lt; 0.05. Results. Initially, a high percentage of the effectiveness of the most important compression and relaxation parameters of the chest was obtained during 2-minute out-of-hospital cardiopulmonary resuscitation with no statistically significant differences between the two groups (PRE/C: 51 mm depth, 83.92% relaxation, frequency 115.46 vs. PRE/I: depth: 47.58 mm, relaxation: 92.54, frequency: 109.96, p &lt; 0.05). After two months, similar parametric values were observed with no statistical significance (p &lt; 0.05). Conclusions. The initial high quality of compressions and relaxation was found in nurses participating in the simulated out-of-hospital SCA, while there were no significant differences between primary health care nurses working at conservative departments and nurses from surgical ones. After a two-month interval from the initial examination and training, high CPR effectiveness was observed based on the guidelines of the European Resuscitation Council from 2015.

European Resuscitation Council Guidelines for Resuscitation: 2018 Update – Antiarrhythmic drugs for cardiac arrest

This European Resuscitation Council (ERC) Guidelines for Resuscitation 2018 update is focused on the role of antiarrhythmic drugs during advanced life support for cardiac arrest with shock refractory ventricular fibrillation/pulseless ventricular tachycardia in adults, children and infants. This update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The ILCOR CoSTR suggests that any beneficial effects of amiodarone or lidocaine are similar. This ERC update does not make any major changes to the recommendations for the use of antiarrhythmic drugs during advanced life support for shock refractory cardiac arrest.

Cost minimization analysis for basic life support

BackgroundThe use of online teaching methodology for basic life support (BLS) courses is progressively increasing. ObjectiveThe objective of this study was to verify whether the blended-learning methodology (virtual course with a short face-to-face complement) was more efficient than a course that followed the classical or face-to-face methodology in our university. Materials and methodsA cost minimization analysis was performed for two BLS and automatic external defibrillation (AED) courses, one of which was conducted face-to-face (Control Group) and the second of which was conducted via blended-learning (Experimental Group). The courses had the same duration and content according to the European Resuscitation Council (ERC) recommendations. In the face-to-face course, direct costs were considered those generated by the faculty and derived from the academic activity. Other costs were those generated by the use of classrooms and the amortization of manikins and AED training. The perspective of the analysis was that of the provider, the academic, and a time horizon of six months. The costs are expressed in € 2017. ResultsThe savings of a course in BLS-AED based on the blended-learning methodology calculated for a total of 160 university nursing and medical students were € 2328.8 for the first year of its implementation and € 9048.8 for its second edition compared with the same course using a face-to-face methodology. ConclusionsThe blended-learning methodology supposes a cost savings for BLS-AED courses, mainly due to the reduction of expenses of the teaching staff. The blended-learning methodology seems to be more efficient than the face-to-face methodology.

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.

Medical Correctness and User Friendliness of Available Apps for Cardiopulmonary Resuscitation: Systematic Search Combined With Guideline Adherence and Usability Evaluation.

BackgroundIn case of a cardiac arrest, start of cardiopulmonary resuscitation by a bystander before the arrival of the emergency personnel increases the probability of survival. However, the steps of high-quality resuscitation are not known by every bystander or might be forgotten in this complex and time-critical situation. Mobile phone apps offering real-time step-by-step instructions might be a valuable source of information.ObjectiveThe aim of this study was to examine mobile phone apps offering real-time instructions in German or English in case of a cardiac arrest, to evaluate their adherence to current resuscitation guidelines, and to test their usability.MethodsOur 3-step approach combines a systematic review of currently available apps guiding a medical layperson through a resuscitation situation, an adherence testing to medical guidelines, and a usability evaluation of the determined apps. The systematic review followed an adapted preferred reporting items for systematic reviews and meta-analyses flow diagram, the guideline adherence was tested by applying a conformity checklist, and the usability was evaluated by a group of mobile phone frequent users and emergency physicians with the system usability scale (SUS) tool.ResultsThe structured search in Google Play Store and Apple App Store resulted in 3890 hits. After removing redundant ones, 2640 hits were checked for fulfilling the inclusion criteria. As a result, 34 apps meeting all inclusion criteria were identified. These included apps were analyzed to determine medical accuracy as defined by the European Resuscitation Council’s guidelines. Only 5 out of 34 apps (15%, 5/34) fulfilled all criteria chosen to determine guideline adherence. All other apps provided no or wrong information on at least one relevant topic. The usability of 3 apps was evaluated by 10 mobile phone frequent users and 9 emergency physicians. Of these 3 apps, solely the app “HELP Notfall” (median=87.5) was ranked with an SUS score above the published average of 68. This app was rated significantly superior to “HAMBURG SCHOCKT” (median=55; asymptotic Wilcoxon test: z=−3.63, P<.01, n=19) and “Mein DRK” (median=32.5; asymptotic Wilcoxon test: z=−3.83, P<.01, n=19).ConclusionsImplementing a systematic quality control for health-related apps should be enforced to ensure that all products provide medically accurate content and sufficient usability in complex situations. This is of exceptional importance for apps dealing with the treatment of life-threatening events such as cardiac arrest.

Abstract 214: Basic Life Support Instructors Overestimate Their Own Ability to Perform Cardiopulmonary Resuscitation

Introduction: High-quality cardiopulmonary resuscitation (CPR) increases survival from cardiac arrest. Laypeople attend basic life support (BLS) courses to learn CPR, but unfortunately, skill quality and retention are often poor. BLS instructors teach by demonstrating CPR skills. However, BLS instructors’ ability to correctly demonstrate CPR remains to be investigated. Aim: To determine BLS instructors’ competence in demonstrating CPR skills. Methods: Certified BLS instructors were asked to demonstrate CPR on a resuscitation manikin (AMBU ® Man, AMBU) in a simulated teaching setting but without verbal explanations. Data on CPR quality was collected from the manikin and the first three cycles of CPR were analyzed. Correct CPR was defined according to the European Resuscitation Council 2015 Guidelines: chest compression (CC) depth of 50-60 mm, CC rate of 100-120 min -1 , and rescue breath volume of 500-600 mL. Instructors were asked to rate their own ability to perform CPR on a 5-point Likert scale before the demonstration and after receiving a performance report thereof. Results: Data from 125 certified instructors were analyzed. Median instructor age was 45 years (Q1;Q3: 30;56), 72% were male, and instructor experience was 8 years (3;14) with a median of 14 courses/year (6;44)). Mean CC depth was 64 mm (SD: 7.3). In total, 22% of chest compressions were performed within guideline recommendations (72% were too deep and 5% were too shallow). Mean CC rate was 115 min -1 (10.8). Full recoil was achieved in 86% of CCs. Of all attempted rescue breaths, 94% resulted in any amount of air registered (mean volume: 499 mL (291)). Only 11% of rescue breaths were within guideline recommendations (52% were too shallow and 37% were excessive). Instructors rated their ability to perform CCs lower after receiving a performance report (p=0.02). Similarly, ratings of rescue breathing ability were lower after receiving a performance report (p=0.01). Conclusion: Certified and experienced BLS instructors performed CC with excessive depth, but with acceptable CC rate and recoil. Instructors were unable to correctly demonstrate rescue breathing. Instructors overrated their ability to demonstrate correct CPR even when provided with their own CPR performance report.

Relationship between body temperature, neuron-specific enolase, and clinical course in patients after out-of-hospital cardiac arrest

According to ILCOR (International Liaison Committee on Resuscitation) recommendations (released in 2003), use of therapeutic hypothermia is recommended for unconscious adult patients who have survived acardiac arrest regardless of the initial monitored cardiac rhythm. Thereby, the treatment goal is to achieve and maintain abody temperature of 32-34 °C for aperiod of 12-24 h. According to the October 2015 recommendations of the European Resuscitation Council (ERC), targeted temperature management (TTM) remains part of treatment, but, as an option, it is advised that the targeted body temperature be 36 °C rather than 32-34 °C. For anon-randomized retrospective observational study, atotal of 149 patients were treated with cardiopulmonary resuscitation (CPR) between May 1999 and September 2009. For the first 4days after CPR, data associated with demography, resuscitation, therapy (temperature course, neuron-specific enolase [NSE]) and clinical-neurological development (Glasgow Outcome Scale [GOS]) were collected. In the study, patients receiving mild hyperthermia were compared with those who did not receive hypothermia. Of the 149 patients included, 90were treated with mild hypothermia (as decided by the attending physician), while 59 received no hypothermia therapy. Assessment reveals that mild hypothermia positively influences clinical-neurological progression, but not survival. On day three and four, patients with an unfavorable neurological progression exhibited significantly increased serum levels of NSE (day4: 108.7 ± 137.3 ng/ml versus 25.5 ± 15.4 ng/ml). Patients receiving hypothermia showed lower average NSE levels compared with persons not receiving hypothermia. Furthermore, during the first 4days, their NSE values tended to increase slower (NSE value at day4: 55.9 ± 64.9 ng/ml versus 129.9 ± 174.9 ng/ml). The best cut-off-value for an unfavorable neurological result was 74.2 ng/ml at day four (specificity 100%, sensitivity 48.6%). For the group of patients who received hypothermia, the best cut-off-value was 74.2 ng/ml at day four (specificity 100%, sensitivity 40.9%), and, for the comparison group, best cut-off-value was 25.5 ng/ml at day three (specificity 100%, sensitivity 88.2%). After out-of-hospital resuscitation, there is a trend for improved clinical-neurological progression with mild hypothermia but it does not influence the prognostic significance of serum NSE. After assessment of available data, it is not possible to recommend uniform cut-off values for patients who received mild therapeutic hypothermia and for those who did not receive hypothermia treatment.

Use of targeted temperature management post cardiac arrest

The term, targeted temperature management (TTM), is used to describe the management of a patient’s body temperature following cardiac arrest and has replaced the term therapeutic hypothermia. TTM has three phases: induction, maintenance and rewarming. A targeted temperature is set to provide neuroprotection and better clinical outcomes for post cardiac arrest patients. The targeted temperature ranges between 32 and 36°C for 12–24 hours with the avoidance of hyperthermia for up to 72 hours. There are three common methods to undertake TTM: conventional cooling techniques, surface cooling systems and intravascular cooling systems. Nurses need to be able to apply, monitor and manipulate the system being used to ensure that adequate TTM is provided. Nurses will also need to monitor the patient for any physiological changes that can occur as a result of the TTM and apply treatment strategies where appropriate. The European Resuscitation Council (2015) has published guidelines on the use of TTM in post cardiac arrest patients and these will also be discussed.

Optimum Chest Compression Point for Cardiopulmonary Resuscitation in Children Revisited Using a 3D Coordinate System Imposed on CT: A Retrospective, Cross-Sectional Study.

The optimum chest compression site (P_optimum) in children is debated: European Resuscitation Council recommends one finger breadth above the xiphisternal joint, whereas American Heart Association proposes the lower sternal half. Using a coordinate system imposed on CT, we aimed to determine the pediatric P_optimum to maximize stroke volume, the key point for successful cardiopulmonary resuscitation, while minimizing hepatic injury. Retrospective, cross-sectional study. University hospital. Children 1-15 years old who underwent chest CT. None. We defined zero point (0, 0) as the center of the xiphisternal joint designating leftward and upward directions of the patients as positive on each axis. P_optimum (x_max. left ventricle, y_max. left ventricle) was defined as the center of the maximum diameter of the left ventricle, whereas P_aorta (x_aorta, y_aorta) as that of the aortic annulus. To compress the left ventricle exclusively, y_max. left ventricle should range above the y coordinate of hepatic dome (y_liver_dome) and below y_aorta. Data were presented as median (interquartile range) and compared among age groups 1.0-5.0, 5.1-10.0, and 10.1-15.0 years using Kruskal-Wallis test. For universal application regardless of age, y coordinates were converted into relative ones with unit of sternal top: 1 unit of sternal top was the y coordinate of the sternal top. A total of 163 patients were enrolled, median age 8.8 year (4.2-14.3 yr). Among age groups, no significant difference was observed in y_max. left ventricle, relative y_max. left ventricle, y_aorta, and y_liver_dome: 1.0 cm (0.1-1.9 cm), 0.10 unit of sternal top (0.01-0.18 unit of sternal top), 0.39 unit of sternal top (0.30-0.47 unit of sternal top), and -0.14 unit of sternal top (-0.25 to -0.03 unit of sternal top), respectively. The probability to compress the left ventricle exclusively was greater than or equal to 96% when placing hand at 0.05-0.20 unit of sternal top. Subgroup analysis demonstrated the following regression equation: x_max. left ventricle (mm) = 0.173 × (height in cm) + 13 (n = 106; p < 0.001; R = 0.278). Theoretically, pediatric P_optimum is located 1 cm (or 0.1 unit of sternal top) above the xiphisternal joint.