European Resuscitation Council Research Articles

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial.

Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the posi-tion of the rescuer during resuscitation. This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations. Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median per-centage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min-1), and lowest for scenario A (9 × min-1). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.

Confusion Around Therapeutic Temperature Management Hypothermia After In-Hospital Cardiac Arrest?

Over the past 15 years, therapeutic temperature management (TTM) has become an increasingly important goal of care in critically ill patients with acute brain injury. TTM (initially defined as cooling to 32oC−34oC) was used with increasing frequency to treat patients with postanoxic/hypoxic encephalopathy caused by catastrophic events such as neonatal asphyxia or cardiac arrest (CA). In the case of CA, using TTM was supported by the results of 2 randomized controlled trials and 45 nonrandomized (mostly before/after) studies. Guidelines from the American Heart Association and European Resuscitation Council have recommended the use of TTM for postanoxic injury after witnessed CA since 2003, and after an initially slow uptake, especially in the United States, application and implementation of these guidelines increased significantly in recent years, with growing consensus on the importance of TTM. However, this trend is currently under threat. In 2013, a large randomized controlled trial by Nielsen and coworkers reported that outcomes in patients with CA cooled to 33oC were not better than in patients cooled to 36oC, leading to a highly contentious debate in the TTM field. Strong opinions on this issue range from accepting the results of the Nielsen study and changing the target temperature to 36oC to staying with a target of 32oC−33oC because of perceived problems with the trial. We support the latter view and have criticized the Nielsen study in these pages for possible selection bias, up to 4-hour delays in initiation of cooling, prolonged (average 10 hours) time …

Danish first aid books compliance with the new evidence-based non-resuscitative first aid guidelines

BackgroundThe European Resuscitation Council (ERC) released new guidelines on resuscitation in 2015. For the first time, the guidelines included a separate chapter on first aid for laypersons. We analysed the current major Danish national first aid books to identify potential inconsistencies between the current books and the new evidence-based first aid guidelines.MethodsWe identified first aid books from all the first aid courses offered by major Danish suppliers. Based on the new ERC first aid guidelines, we developed a checklist of 26 items within 16 different categories to assess the content; this checklist was adapted following the principle of mutually exclusive and collectively exhaustive questioning. To assess the agreement between four raters, Fleiss’ kappa test was used. Items that did not reach an acceptable kappa score were excluded.ResultsWe evaluated 10 first aid books used for first aid courses and published between 2009 and 2015. The content of the books complied with the new in 38% of the answers.In 12 of the 26 items, there was less than 50% consistency. These items include proximal pressure points and elevation of extremities for the control of bleeding, use of cervical collars, treatment for an open chest wound, burn dressing, dental avulsion, passive leg raising, administration of bronchodilators, adrenaline, and aspirin.ConclusionsDanish course material showed significant inconsistencies with the new evidence-based first aid guidelines. The new knowledge from the evidence-based guidelines should be incorporated into revised and updated first aid course material.

Сучасний спосіб судинного доступу при критичних станах у дітей

To provide a vascular access is the main task during the first minutes of resuscitation, but it should not interrupt the chest compression or ventilation. Vascular access includes the catheterization of peripheral vein or intraosseous space. The European Resuscitation Council in 2005 has recommended to establish the practice of intraosseous access (IOA) during resuscitation. The following updates of the European Resuscitation Council Recommendations (2010, 2015) has also considered that it necessary to use intraosseous access during cardiopulmonary resuscitation. The emergency physician should use intraosseous access as useful alternative to peripheral venous access. Intraosseous access has all advantages of central venous access, but it is much easier and faster. Consequently, in case of cardiac arrest and apnoea as well as decompensated shock, when the introduction of adrenaline and/or infusion solutions is the first-line treatment, the most appropriate vascular access is intraosseous one. Provided that the procedure is performed in compliance with aseptic rules, the risk of infectious complications is very low. However, intraosseous access should be transitional vascular access and should be removed as soon as possible. Its use must never exceed 24 hours.

Comparing Effectiveness of Video-Assisted Oral Debriefing versus Oral Debriefing Alone During Human Resuscitation Simulation: A Randomized Trial

Aim of the study: Debriefing is central to simulation-based education. As its optimal format is unknown, video-feedback may optimize the learning process. The purpose of the study was to evaluate the potential benefits of videoassisted oral debriefing (VAOD) versus oral debriefing alone (ODA) for improving performance in a Basic Life Support with an Automated External Defibrillator (BLS/ AED) scenario. Methods: One hundred and forty candidates (physicians and nurses) were enrolled in the study. After performing a pretest scenario, participants were randomized into two groups to receive a facilitated debriefing: either ODA or VAOD. Participants were then asked to complete a posttest scenario. Pre- and posttests were video recorded to allow a blinded independent reviewer to rate each participant’s skills in both tests, using the European Resuscitation Council BLS/AED provider assessment record tool. Results: Overall BLS/AED resuscitation performance scores improved in both groups [mean (SD), 57.08% (1.77%) for ODA pretests vs. 89.77% (2.15%) for ODA posttests (p<0.001); 64.31% (2.54%) for VAOD pretests vs. 91.15% (3.08%) for VAOD posttests (p=0.06)]. Score improvement was not found to be very different between the two groups (+33% for ODA vs. +27% for VAOD, p=0.06). Conclusion: Using VAOD in human resuscitation simulation did not show any advantage over ODA and did not enhance its impact on the participants’ perception. However, our results suggested that the use of a debriefing process (either oral or video-assisted) contributes to a significant improvement in resuscitation skills.

Kontinualno praćenje vanbolničkog srčanog zastoja na teritoriji opštine Sombor - EuReCa_Srbija

Aims: Epidemiological follow up of out-of-hospital cardiac arrest (OHCA) in Municipality Sombor in period of 1st of January 2016 until 1st of June 2017. With focus on OHCA quality management. METODOLOGIJA: The project EuReCa is a part of a metacentric, observational, prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The EuReCa_Srbija project is conducted by the Serbian Resuscitation Council, based on collaboration with the European Resuscitation Council with support of the Section of Emergency Medicine - Serbian Physicians Society. The data's from the Serbian cardiac arrest registry has been collected and analyzed via www.eureca.rs application. Results: Emergency medical service (EMS) in Sombor covers 85.900 citizens. In observed period 119 (138,5/100.000) OHCA's were registered. Cardiopulmonary resuscitation (CPR) was applied 94 (109,4/100.000) cases. Gender distribution shows that 58 OHCA occurred in male and 36 in female population. The most common etiological cause of OHCA had cardiac background in 61 (71/100.000) patinets. Home is the most common place where OHCA occurred in 69 cases with incidence 80,3/100.000). Witness was present 61 OHCA (71/100.000), and lay-person CPR was performed in 19 (22/100.000) patients until the arrival of the EMS. TeleCPR by the dispatcher was registered in 14 (16,2/100.000) cases. The initial shockable rhythm (pulseless ventricular tachycardia pVT /ventricular fibrillation VF) was observed in 30 (34,9/100.000) patients, and nonshockable rhythm (asistoly/ PEA) in 64 (74,5/100.000). Automated external defibrillator (AED) was never used. Return of spontaneous circulation (ROSC) was achieved in 51 (59,3/100.000) cases. At circadian ROSC distributionROSC was most commonly achieved in period between 6-14 hours. Hospital OHCA discharge survival was 6 (6,9/100.000), and the 30-days survival rate is 4 (4,6/100.000). Conclusion: By observing the epidemiological parameters of the OHCA, quality management related points were highlighted. The analyzed data's points to the fact that there is a higher incidence of almost all parameters included in the study protocol compared to previous period. Further observation and analysis will contribute to overall deeper insight of each observed segment that contributed to better and improved outcome with aim to continue the trend of positivity.

Cardiac arrest and cardiopulmonary resuscitation in the operating room

The occurrence of cardiac arrest during anesthesia and surgery is nowadays associated with many challenges imposed by 21st century medicine. On the one hand, good education of healthcare practitioners, sophisticated anesthetic techniques and equipment, along with safer anesthetics and improved surgical techniques have significantly reduced the risk of cardiac arrest during the perioperative period. Still, the introduction of new, invasive diagnostic and therapeutic procedures in the aging patients and those with comorbidities carries along new risk and challenges. Epidemiological data indicate that intraoperative cardiac arrest is an extremely rare event. Due to variety of moral and ethical prejudices, intraoperative cardiac arrest is frequently presented as if it has happened in the immediate postoperative period, following surgery and anesthesia. The preventive measures, the etiology and diagnosis of cardiac arrest, as well as the specificities regarding organization and performance of cardiopulmonary resuscitation in the operating room, result in a better prognosis compared to other hospital departments. The article also describes the specifics of cardiopulmonary resuscitation in the catheterization laboratory, while a separate section is dedicated to cardiopulmonary resuscitation following systemic toxicity of local anesthetics. Since intraoperative cardiac arrest and death represent very rare complications, European Resuscitation Council has only recently published Guidelines for Resuscitation for performing cardiopulmonary resuscitation in the operating room ? in 2015.

The Emergency Department Crash Cart: A systematic review and suggested contents.

As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC. Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

EuReCa_Serbia - koliko smo napredovali?

Aim: The aim of this paper was to compare the collected data's during EuReCa project and to appoint the influence of it to the quality management of the cardiac arrest in participating areas. Methodology: The project EuReCa is a part of a metacentric, observational, prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The data's from the Serbian cardiac arrest registry has been analyzed in period of 1st of October 2014 until 1st of August 2017 from www.eureca.rs application. Results: In the observed period, 4172 EuReCa events have been registered. Cardiopulmonary resuscitation (CPR) is performed in 1618/4172 or 37,78% of all cases. CPR in 2014 apply in 465/1490 cases (31,2%) , during 2015 in 469/1366 (34,3%), in 2016 at 473/952 (49,7%) and for 2017. in 211/365 (58%) cases. The initial shockable rhythm (pulseless ventricular tachycardia pVT /ventricular fibrillation VF) during 2014 was present at 80 patients out of 465 ongoing CPR's (17,20%), in 2015. 88/469 (18,76%), during 2016 111/473 (23,47%) and in 2017 the figures are 60/211 (28,44%). Return of spontaneous circulation (ROSC) was achieved in 2014 at 75/465 (16,12 %) and during 2017 in 50/211 (23,70%) patients. The hospital discharge in observed period was 63/1618 (3,89%), where 15/465 (3,23%) goes for 2014, 18/469 (3,84) for 2015, 20/473 (4,23) for 2016 and 10/211 (4,74%) in 2017. The 30-days survival rate was 7/465 (1,15%) in 2014 and 7/211(3,32%) patients in 2017. Conclusion: The results unambiguously indicate significant increase in survival rate in patients with out-of-hospital cardiac arrest registered in EuReCa database. In the forthcoming period, the focus will be directed into the contributing factors that lead to the improvement in end-results of outs-of hospital cardiac arrest management and healthcare centers'.

Primena ultrazvuka u urgentnoj medicini i resuscitaciji

Aim: The aim of this paper is to show the concept of the treatment of the patients in cardiac arrest and the achievements and advantages of the use of ultrasound in cardiac arrest, comparing existing protocols for emergency care with the protocols we developed in the Resuscitation Council of Serbia and in cooperation with other national councils, the possibility of delayed application of ultrasound in order to further final diagostics and the establishment of therapeutic procedures as well as the use of ultrasound during transport and prolonged field care under out-of-hospital conditions (transport longer than 45 min) or work in the “remote area” in mountain areas. METHODOLOGY: The methodology of work reviewed literature (books, published articles) in the field of the application of ultrasound in emergency medicine. The bibliography database MEDLINE was used as a browser. THE RESULTS: According to the latest guidelines of the European Resuscitation Council, the use of ultrasound is recommended for the determination of reversible causes in cardiac arrest. Procedures that are carried out to determine reversible causes of cardiac arrest fall under red-eye procedures and these patients require urgent care. Ultrasonography has a place in diagnosing the following reversible causes of cardiac arrest: tension pneumothorax, hypoxemia, hypovolaemia, cardiac tamponade and pulmonary thromboembolism. Procedures that work in the yellow and green zone give the possibility of delayed application of ultrasound aiming for final diagnostics and establishment of therapeutic procedures. The use of ultrasound can be beneficial during transportation and prolonged field care in outhospital conditions (transport longer than 45 min) or work in the remote areas in mountains. One of the procedures in the yellow or green zone is the application of the FAST protocol. CONCLUSION: The use of ultrasound in emergency medicine, according to available literature, points to the benefit of implementing these diagnostic procedures in order to better and better manage critically ill patients. The education of the physiscians dealing with emergency medicine in the field of ultrasonography leads to a decrease in human resources and more efficient treatment of patients and to the possibility of implementing salvage (red procedures) in life-threatening conditions.

THE IMPACT OF RESPIRATORY MUSCLE FATIGUE ON THE QUALITY AND EFFICIENCY OF RESCUE ACTION

INTRODUCTION The lifeguard is the person in charge of safety in water environments. After a rescue, it is possible that he has to execute a CPR. The European Resuscitation Council (ERC) as well as theAmerican Heart Association are currently encouraging a quality CPR performance. The lifeguard may be obliged to carry out a CPR during a long period of time as the response of the Emergency Medical Service takes 5–8 min on average and it can even reach 20 min. The normal respiratory muscle effort at maximal swimming intensity requires a significant fraction of cardiac output and causes leg blood flow to fall. The main objective of this paper was to determine respiratory muscle fatigue (RMF) level in swimming with different intensity on quality and efficiency rescu action in the water. MATERIAL AND METHODS The study involved eleven lifeguards male (9) and female (2); age: (24.25±1.5); body height( 176,27±7,88) and body mass (75.81±11,01)form University School of Physical Education, Cracow. Two tests were conducted: the first test involved the execution of 5 min of CPR (rested), and the second one in performing water rescue and subsequent CPR (exhausted) for 5 minutes. The quality of the CPR at rest and at fatigue condition was compared. The recording instrument was the Ambu Defib Trainer W (Wireless).The time and precision of the simulated water rescue was also registered. Two spirometry tests were performed the first test was set before swimming and the second after (exhausted). Maximal respiratory pressures (PImax, PEmax) were evaluated before and directly after swimming in different intensity.The quality of the respiratory muscle fatigue at rest and at fatigue condition was compared. The recording instrument was portable MicroLoop spirometer. RESULTS After e simulated water rescue significantly increase parameters such as: ventilation minute volume rested (3,06±22,10) exhausted (4,23 ±22,10. P &lt; .001); ventilation rate rested (3.60±34.80) exhausted (4,80 ±34.80. P &lt; .001); and stomach inflation rested (2,0±20,47) exhausted (5.80 ±20.47. P &lt; .001). The greatest variation in the results of the respiratory muscle fatigue both before and after swimming with different intensity was observed only in two parameters: maximal ventilation index (MVV) and peak exhaust flow (PEF). CONCLUSIONS The accumulated fatigue during a simulated water rescue performed by lifeguards reduces the quality of compression depth and pause between compressions. The following respiratory parameters were found to have the strongest effect on the swimming: during maximum exercise intensity and FEV 1 (-0.77) rested and FEV 1 (-0.57) exhausted and FVC (-0.79) rested and FVC (-0.70) exhausted.

European Resuscitation Council Guidelines for Resuscitation: 2017 update

European Resuscitation Council Guidelines for Resuscitation: 2017 update

Comparison of manual and mechanical cardiopulmonary resuscitation on the move using a manikin: a service evaluation

Aim: The aim of this study was to assess the effect that transporting a patient has on the quality of cardiopulmonary resuscitation (CPR) provided during pre-hospital resuscitation. Utilising the 2010 European Resuscitation Council (ERC) guidelines as a framework, one- and two-person manual CPR (SCPR) and mechanical CPR (MCPR) were directly compared in a simulated prehospital transport setting. Methods: Ten practising paramedics each volunteered to participate in four pre-hospital CPR scenarios. The MCPR device used for this study was the LUCASTM2. Data were captured electronically using QCPRTM wireless technology (Resusci Anne® Wireless SkillReporterTM manikin and software by Laerdal Medical©). Results: A reduction in the rate, depth and percentage of correct compressions was noted when the paramedics were moving the patient. In relation to the 2010 ERC guidelines, the SCPR did not meet current guidelines and was of more variable quality than MCPR. MCPR was consistent and conformed to the guidelines. However, the application of the LUCASTM2 when only one paramedic was present resulted in a significant delay in commencing chest compressions. Conclusion: In the pre-hospital setting, transporting a patient during a cardiac arrest can have a deleterious effect on the quality of chest compressions being provided. When provided by a mechanical device rather than manually, the quality of chest compressions produced is closer to that currently recommended, but two persons would be required for timely deployment of the device and to maximise the chest compression fraction. This could suggest a potential use for pre-hospital MCPR even in the absence of recommendation for routine use. Keywords CPR; mechanical CPR; transport

The opinion of health professionals regarding the presence of relatives during cardiopulmonary resucitation

BackgroundThe latest recommendations from the American Heart Association and the European Resuscitation Council invite allowance for the presence of relatives (PR) during cardiopulmonary resuscitation (CPR) as an extra measure of family care. ObjectiveTo discover the opinion of health professionals on the PR during CPR. MethodCross-sectional observational study through an online survey in Spain, based on a non-probability sample (n=315). Results45% consider that the PR during CPR is not demanded by users. 64% value the implementation of this practice in a negative or a very negative way. 45% believe that the practice would avoid the feeling of abandonment that is instilled in the relatives, this being the most widely perceived potential benefit. 30% do not believe that it can help reduce the anxiety of relatives. The majority remarked that PR would cause situations of violence, psychological harm in witnesses, and more mistakes during care. 48% feel prepared to perform the role of companion. ConclusionsMost professionals perceive more risks than benefits, and are not in favour of allowing PR due to a paternalistic attitude, and fear of the reactions that could be presented to the team. Extra-hospital emergency personnel seems to be the group most open to allowing this practice. Most professionals do not feel fully prepared to perform the role of companion.

Role of bispectral index monitoring and burst suppression in prognostication following out-of-hospital cardiac arrest: a systematic review protocol

BackgroundOut-of-hospital cardiac arrest (OHCA) is associated with significant mortality or may have a poor neurological outcome. Various community-training programmes have improved practices like bystander cardiopulmonary resuscitation (CPR) and early defibrillation using automated external defibrillator (AED). Post-resuscitation care has also changed significantly in the millennium. Interventions like targeted temperature management (TTM), avoidance of hyperoxia and emergency cardiac catheterisation have given patients a chance of a better neurological outcome. Despite these timely interventions, it is still very difficult to predict neurological outcome. The European Resuscitation Council and European Society of Intensive Care Medicine (ERC-ESICM) published guidance in 2015 with a strong recommendation to delay prognostication for at least 72 h and with an emphasis to adapt a multimodal approach, which includes neurological examination, biomarkers, electroencephalogram (EEG) and radiological tests. These interventions not only have cost attached to them, but the unpredictability has a significant emotional impact on family members. Bispectral index (BIS) monitoring device acts on the principle of EEG and converts the waveform into an absolute number and also measures the burst suppression. We hypothesize that patients who have a low BIS value and high burst suppression within 24 h of presentation will have a poor neurological outcome. The primary objective of this review is to look at BIS monitor as a tool, which could help bring forward the timing of prognostication.MethodsElectronic databases will be systematically searched for randomised controlled trials and prospective or retrospective cohort studies with no language restrictions. The search will be supplemented with grey literature searches of thesis, dissertations and hand searching of relevant journals. Two independent reviewers will screen, select and perform analysis according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) method. The selected studies will be analysed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. Meta-analysis will be performed if suitable.DiscussionThis review will synthesize the evidence on the use of BIS monitors within 24 h of achieving return of spontaneous circulation (ROSC) and may help in early prognostication.Systematic review registrationPROSPERO CRD 42016050224.

Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

BackgroundCardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AimTo describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OHCA and compare it with the European Resuscitation Council 2010 and 2015 Guidelines. MethodsWe included OHCA cases from the Capital Region, Denmark, (2012–2016) where a Zoll AED was used before ambulance arrival. For cases with at least one minute of continuous data, the initial 10min of CPR data were analysed for compression rate, depth, fraction and compressions delivered for each minute of CPR. Data are presented as median [25th;75th percentile]. ResultsWe included 136 cases. Bystander median compression rate was 101min−1 [94;113], compression depth was 4.8cm [3.9;5.8] and compressions per minute were 62 [48;73]. Of all cases, the median compression rate was 100–120min−1 in 42%, compression depth was 5–6cm in 26%, compression fraction≥60% in 51% and compressions delivered per minute exceeded 60 in 54%. In a minute-to-minute analysis, we found no evidence of deterioration in CPR quality over time.The median peri-shock pause was 27s [23;31] and the pre-shock pause was 19s [17;22]. ConclusionsThe median CPR performed by bystanders using AEDs with audio-feedback in OHCA was within guideline recommendations without deterioration over time. Compression depth had poorer quality compared with other parameters. To improve bystander CPR quality, focus should be on proper compression depth and minimizing pauses.

A pilot study of flipped cardiopulmonary resuscitation training: Which items can be self-trained?

Objective: This study evaluated self-trained basic life support (BLS) skills acquired from an e-learning platform to design a complementary in-class training approach. Design: In total, 41 students (15–17 years, 29 men) participated in a pilot study on self-training in BLS. After 6 weeks, a compression-only cardiopulmonary resuscitation (CPR) test assessed the skills acquired. Setting: A practice-based research setting. All data were collected in Flemish secondary schools in the context of the regular school curriculum. Methods: All tests were video-recorded. Data on motor skills were additionally collected on a Resusci Anne mannequin with Skillreporting software®. Quantitative data were analysed by analysis of variance (ANOVA). The qualitative aspects of basic life-saving actions were evaluated using European Resuscitation Council (ERC) guidelines. Results: Alerting emergency services, checking for consciousness and placing electrodes can be learned autonomously and be taught by means of pre-instruction. Hands-on training is necessary for compression skills and freeing the airway. Conclusion: Self-training in BLS offers insight into a flipped classroom CPR training strategy. Hands-on training should focus on motor skills, including head tilt and compression depth.

Public awareness about the use of automatic external defibrillator (AED) in giving first aid

Abstract Introduction. Chances for survival of a patient who has suffered from sudden cardiac arrest (SCA) depend on a number of factors. One of the most important however, is the time within which the patient is provided with actions to restore normal heart function. In the Guidelines for Resuscitation 2015, The European Resuscitation Council states that defibrillation done within 3-5 minutes since a patient with SCA lost his/her consciousness can increase the survival rate up to 50-70%. However, such a short time of providing help is only achievable through the implementation of universal defibrillation programs and the automatic external defibrillator (AED) devices densely distributed in public places. By contrast, every minute of delay in defibrillation reduces the probability of survival by approximately 10-12% until the hospital discharge. Aim. The purpose of the research was to elicit the opinions of adult respondents on first aid and the use of automatic external defibrillator (AED). Material and methods. The research method used in this paper was a diagnostic survey, the technique was a web-based questionnaire, and a research tool was the authors’ own questionnaire survey. The survey was active between April 8, 2016 and May 20, 2016. During this time, 116 opinions were collected. Results. As many as 77% of respondents declared that they had attended a first aid course, but 21% of them stated that they no longer remembered the knowledge acquired. The number of 63% of respondents did not know what an automatic external defibrillator is. Only 27% of respondents knew that AEDs are public devices, and only 47% believed that using an AED would not worsen the health of the victim. Conclusions. The availability of AEDs and knowledge of their use are insufficient. Low social awareness and irrational fear of using an AED (fear of deterioration of the victim’s health) support the need for continuing education in this area.

Lifeline ARM is more effective than manual cardiopulmonary resuscitation during ambulance transport: A prospective randomized crossover manikin trial

Purpose: According to the 2015 European Resuscitation Council guidelines, the quality of external chest compressions (CCs) is a key element improving the outcome in cardiopulmonary resuscitation (CPR). However, as indicated in many studies, the performance of CPR is highly variable [ 1 Kurowski A. Szarpak Ł. Bogdański Ł. Zaśko P. Czyżewski Ł. Comparison of the effectiveness of cardiopulmonary resuscitation with standard manual chest compressions and the use of TrueCPR and PocketCPR feedback devices. Kardiol Pol. 2015; 73(10): 924-930https://doi.org/10.5603/KP.a2015.0084 Crossref Scopus (30) Google Scholar , 2 Abelairas-Gómez C. Barcala-Furelos R. Szarpak Ł. García-García Ó. Paz-Domínguez Á. López-García S. et al. The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation. Kardiol Pol. 2017; 75(1): 21-27https://doi.org/10.5603/KP.a2016.0165 Crossref Scopus (25) Google Scholar ]. Our aim was to examine if CCs were more effective with the use of newly developed mechanical CC device, Lifeline ARM (ARM) as compared with standard manual CCs.

Knowledge and willingness to perform basic life support by local police officers

To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables. Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables. Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years. Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers. Key words. Police. Cardiopulmonary resuscitation. Out-of-hospital cardiac arrest; attitude. Emergencies.