High-quality Cardiopulmonary Resuscitation Research Articles

Implementation of a Smart Teaching and Assessment System for High-Quality Cardiopulmonary Resuscitation.

The purpose of this study is to develop a smart training and assessment system called SmartCPR, for teaching and training cardiopulmonary resuscitation (CPR), based on human posture estimation techniques. In this system, trainees can automatically recognize and evaluate whether chest compressions during CPR meet the standard of high-quality CPR by simply using a device such as a smart phone. Through the system, trainees are able to obtain real-time feedback on the quality of compressions so that they can adjust the cycle, depth, frequency, and posture of compressions to meet the standard of high-quality CPR. In addition, the SmartCPR system is convenient for CPR trainers. Trainers can instantly and accurately assess whether the trainee's compressions meet the standard of high-quality CPR, which reduces the risk of manual assessment errors and also reduces the trainer's teaching pressures. Therefore, the SmartCPR system developed in this study can be an important tool for CPR teaching and training for physicians, which can provide training and guidance for high-quality CPR maneuvers and enable trainees to become more proficient in CPR and self-training.

Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India.

High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles. Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, et al. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med 2024;28(4):336-342.

Comparison of the effects of using feedback devices for training or simulated cardiopulmonary arrest

BackgroundHigh-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC).MethodsWe use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5–6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100–120 cpm).ResultsThe use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device.ConclusionUsing a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

Detection and Evaluation for High-Quality Cardiopulmonary Resuscitation Based on a Three-Dimensional Motion Capture System: A Feasibility Study.

High-quality cardiopulmonary resuscitation (CPR) and training are important for successful revival during out-of-hospital cardiac arrest (OHCA). However, existing training faces challenges in quantifying each aspect. This study aimed to explore the possibility of using a three-dimensional motion capture system to accurately and effectively assess CPR operations, particularly about the non-quantified arm postures, and analyze the relationship among them to guide students to improve their performance. We used a motion capture system (Mars series, Nokov, China) to collect compression data about five cycles, recording dynamic data of each marker point in three-dimensional space following time and calculating depth and arm angles. Most unstably deviated to some extent from the standard, especially for the untrained students. Five data sets for each parameter per individual all revealed statistically significant differences (p < 0.05). The correlation between Angle 1' and Angle 2' for trained (rs = 0.203, p < 0.05) and untrained students (rs = -0.581, p < 0.01) showed a difference. Their performance still needed improvement. When conducting assessments, we should focus on not only the overall performance but also each compression. This study provides a new perspective for quantifying compression parameters, and future efforts should continue to incorporate new parameters and analyze the relationship among them.

Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: Lessons learned from recent clinical trials.

Cardiac arrest is a leading contributor to morbidity and mortality in the United States. Survival has been historically dependent on high-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation. However, a large percentage of patients remain in refractory cardiac arrest despite adherence to structured advanced cardiac life support algorithms in which these factors are emphasized. Veno-arterial extracorporeal membrane oxygenation is becoming an increasingly used rescue therapy for patients in refractory cardiac arrest to restore oxygen delivery by extracorporeal CPR (ECPR). Recently published clinical trials have provided new insights into ECPR for patients who sustain an outside hospital cardiac arrest (OHCA). In this narrative review, we summarize the rationale for, results of, and remaining questions from these recently published clinical trials. The existing observational data combined with the latest clinical trials suggest ECPR improves mortality in patients in refractory arrest. However, a mixed methodstrial is essential to understand the complexity, context, and effectiveness of implementing an ECPR program.

Improving response time and survival in ward based in-hospital cardiac arrest: A quality improvement initiative

BackgroundSurvival in cardiac arrest is associated with rapid initiation of high-quality cardiopulmonary resuscitation (CPR) and advanced life support. To improve ROSC rates and survival, we identified the need to reduce response times and implement coordinated resuscitation by dedicated cardiac arrest teams (CATs). We aimed to improve ROSC rates by 10% within 6 months, and subsequent survival to hospital discharge. MethodsWe used the Model for Improvement to implement a ward-based cardiac arrest quality improvement (QI) initiative across 3 Plan-Do-Study-Act (PDSA) cycles. QI interventions focused on instituting dedicated CATs and resuscitation equipment, staff training, communications, audit framework, performance feedback, as well as a cardiac arrest documentation form. The primary outcome was the rate of ROSC, and the secondary outcome was survival to hospital discharge. Process measures were call center processing times, CAT response times and CAT nurses’ knowledge and confidence regarding CPR. Balancing measures were the number of non-cardiac arrest activations and the number of cardiac arrest activations in patients with existing do-not-resuscitate orders. ResultsAfter adjustments for possible confounders in the multivariate analysis, there was a significant improvement in ROSC rate post-intervention as compared to the pre-intervention period (OR 2.05 [1.04–4.05], p = 0.04). Median (IQR) call center processing times decreased from 1.8 (1.6–2.0) pre-intervention to 1.4 (1.4–1.6) minutes post-intervention (p = 0.03). Median (IQR) CAT response times decreased from 5.1 (4.5–7.0) pre-intervention to 3.6 (3.4–4.3) minutes post-intervention (p < 0.001). After adjustments for possible confounders in the multivariate analysis, there was no significant improvement in survival to hospital discharge post-intervention as compared to the pre-intervention period (OR 0.71 [0.25–2.06], p = 0.53). ConclusionImplementation of a ward-based cardiac arrest QI initiative resulted in an improvement in ROSC rates, median call center and CAT response times.

Effectiveness of Feedback with Mobile Devices for Quality Measure of CPR Training: A Systematic Review

Cardiopulmonary resuscitation (CPR) is a life-saving skill that can significantly increase survival rates in an emergency. Medical professionals, health students, and trained lay people must all perform high-quality CPR. As an outcome, effective CPR training using instruments that support the achievement of high-quality CPR is essential. Objective: This systematic review aimed to evaluate the effectiveness of feedback provided via mobile devices in measuring the quality of CPR training. Method: Design used systematic review with reference to the PRISMA Statement Guidelines 2020. Search results through database of ScienceDirect (778 articles), Wiley Online Library (765 articles), PubMed (55 articles), and ResearchGate (73 articles). The research designs of articles analyzed was randomized controlled trial which published from 2013 to 2023 with the keywords cardiopulmonary resuscitation, CPR training, mobile devices. The sample in this study was taken from five articles that match the inclusion criteria. JBI's critical assessment tool for assessing bias risk in randomly controlled 2023 checklist tests is used to critically evaluate the instruments used for the selected article. Results: The primary results that five publications were based on CPR quality metrics such as chest compression depth and speed, as well as the proportion of acceptable chest compression depth. Conclusions: This review discovered evidence that mobile devices have an effect on the effectiveness of real-time feedback on CPR quality in CPR training. CPR trainees received effective instant guidance from a variety of mobile devices, including smartphones and smart watches equipped with sensors.

A MXene heterostructure-based piezoionic sensor for wearable sensing applications

Humans rely on ion transport to sense and process tactile information. Piezoionic sensor can directly convert mechanical energy into electrical energy through similar ion migration, showing applications in wearable sensing. However, affected by the electrode materials properties, the relatively low voltage output and poor stability of the piezoionic sensors restrict their development. Here, we designed a MXene/Ag nanoparticles heterostructure electrode-based piezoionic sensor with stable and high-performance voltage output. During ion mediated mechanoelectric conversion, the layered MXene nanosheets in electrodes provide transport channels for movable ions. While the interlayer insertion of Ag nanoparticles increases the interlayer spacing between MXene nanosheets, improving the ion storage and transport. Under a bending deformation of 0.7 % strain, the sensor outputs 11.1 mV voltage. The voltage can maintain stable under cyclic deformation for about 13000 s. Based on the excellent mechanical-to-electric conversion, this sensor can be applied to monitor human body activities. The feasibility of the sensor for guiding high-quality cardiopulmonary resuscitation (CPR) training is also demonstrated. Moreover, it can be adhered on the finger to generate pulse or square wave electrical signals by rhythmic bending the finger, which can transmit information based on the coding principle of Morse code. These results indicate the potential of the self-powered piezoionic sensor in medical rehabilitation and human–computer interaction.

Considerations for Medical Students' and Residents' Response to an In-Flight Call for Help.

INTRODUCTION: High quality cardiopulmonary resuscitation and medical care in an emergency can save lives, especially when resources are limited, as when in flight on a commercial airplane. A medical student or resident may be the most qualified person to offer assistance during an in-flight cardiac arrest; however, he/she may not yet have experience acting as a sole provider on the ground. Moreover, physicians-in-training may feel an ethical obligation to help a fellow passenger in need, but later worry that their help is subject to questions of tort liability action. This commentary will discuss who should volunteer to help in flight, considering the capability, ethics, and legal consequences of medical students and residents providing medical assistance on an airplane. It will also discuss how changes in medical curriculum due to the COVID-19 pandemic may aid medical trainees' ability to help during an in-flight emergency as well as propose further opportunities for training.Edelson J, Ruskin K. Considerations for medical students' and residents' response to an in-flight call for help. Aerosp Med Hum Perform. 2024; 95(1):59-60.

Cardiopulmonary resuscitation: knowledge among nurses in selected departments of a teaching hospital, Nepal

Introduction: Cardiopulmonary Resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. If early basic life support CPR is instantiated, the survival rate is improved. This study aims to assess the knowledge regarding CPR among nurses. Method: A descriptive cross-sectional study design was adopted among 150 nurses in critical care area of Patan Hospital Lalitpur Nepal, from January to April 2023. Researcher developed self-administered structured questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences. Result: Study revealed that majority 143(95.3%) of the respondents had knowledge regarding meaning of sudden cardiac death. Same as 137(91.3%) knew the indication of CPR and most of the respondents 140(93.3%) knew the carotid pulse should be checked before starting CPR. More than half 131(87.3%) had knowledge regarding ratio of chest compression. We found more than half respondents 83(55.3%) knew the best time to switch. Nearly half of the respondents 61(40%) knew the component of high-quality CPR whereas minority of the respondents; 20(13.3%) knew the algorithm of adult cardiac arrest. Conclusion: Majority of the respondents had knowledge regarding meaning, indication, site of pulse taking, and ratio of chest compression. Whereas more than fifty percent respondents had knowledge regarding, best time to switch, nearly half of respondents knew the components of CPR. Minority of respondents aware the algorithm of adult cardiac arrest.

Designing of a High-Quality CPR Simulation Game Clinical Scenario for Nursing Students: A Qualitative Study

Cardiopulmonary resuscitation (CPR) is an important skill for nursing students. The process of learning high-quality CPR with a simulation-based learning method can be developed into a simulation game. In order to develop a CPR HQ simulation game, a clinical scenario that can be used as a guide in carrying out storyboards is needed. This research aims to formulate a simulation scenario that will serve as the basis for developing a high-quality CPR simulation game to increase nursing students' competency. This qualitative research uses a Participatory Action Research (PAR) approach by inviting 15 respondents from the prospective user population, namely Emergency Nursing Lecturers, Emergency Room Nurses, BLS Trainers, and nursing students, to carry out Focus Group Discussions. The study's results revealed clinical scenarios that were arranged based on 4 themes, including 1) suitability of the competency being tested, 2) minimum competency for 5 cycles of CPR, 3) settings in the pre-and intrahospital scope, and 4) choice of patient outcome. These components are crucial when designing simulation scenarios that support students’ cognitive processes to achieve High-Quality CPR in nursing students. Thus, the results of this research can then be used as a guide in developing the HQ-CPR game as a learning medium for nursing students.

Impact of Personal Protective Equipment on Cardiopulmonary Resuscitation and Rescuer Safety

Background. High-quality cardiopulmonary resuscitation (CPR) is a key element in the rescue of cardiac arrest patients but is difficult to achieve in circumstances involving aerosol transmission, such as the COVID-19 pandemic. Methods. This prospective randomized crossover trial included 30 experienced health care providers to evaluate the impact of personal protective equipment (PPE) on CPR quality and rescuer safety. Participants were asked to perform continuous CPR for 5 minutes on a manikin with three types of PPE: level D-PPE, level C-PPE, and PAPR. The primary outcome was effective chest compression per minute. Secondary outcomes were the fit factor by PortaCount, vital signs and fatigue scores before and after CPR, and perceptions related to wearing PPE. Repeated-measures ANOVA was used, and a two-tailed test value of 0.05 was considered statistically significant. Results. The rates of effective chest compressions for 5 minutes with level D-PPE, level C-PPE, and PAPRs were 82.0 ± 0.2%, 78.4 ± 0.2%, and 78.0 ± 0.2%, respectively ( p = 0.584 ). The fit-factor test values of level C-PPE and PAPRs were 182.9 ± 39.9 vs. 198.9 ± 9.2 ( p &lt; 0.001 ). The differences in vital signs before and after CPR were not significantly different among the groups. In addition, the fatigue and total perception scores of wearing PPE were significantly higher for level C-PPE than PAPRs: 3.8 ± 1.6 vs. 3.0 ± 1.6 ( p &lt; 0.001 ) and 27.9 ± 5.4 vs. 26.0 ± 5.3 ( p &lt; 0.001 ), respectively. Conclusion. PAPRs are recommended when performing CPR in situations where aerosol transmission is suspected. When PAPRs are in short supply, individual fit-tested N95 masks are an alternative. This trial is registered with NCT04802109.

Does the type of mechanical chest compressor affect resuscitation outcome of out of hospital cardiac arrest patients? A propensity-score based comparison of three devices

Abstract Background Mechanical cardiopulmonary resuscitation (CPR) devices are currently recommended when high-quality CPR could not be provided and only if used by trained rescuers. Guidelines are against their routinely use since clinical trials results are controversial, and solid evidence of improved survival are missing. Moreover, many studies compared these devices to very high-quality manual CPR, hardly replicable in a pre-hospital emergency setting. Nowadays, different machines are available but literature is poor in direct comparison studies. Purpose To assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and of 30-days mortality after an out-of-hospital cardiac arrest (OHCA) as compared to manual standard CPR. Methods Data were prospectively collected from our Utstein-based cardiac arrest registry. We considered all OHCAs from January 1, 2015 to December 31, 2022 from 7 provinces covered by the same regional emergency system (population covered 4.2mln. inhabitants) but equipped with three different types of mechanical compressor: Autopulse®; LUCAS® and Easy Pulse®. Patients treated with mechanical CPR and manual CPR were randomly matched via a multivariable logistic regression propensity score considering age, gender, witnessed OHCA, presence of bystander CPR, first rhythm recorded, EMS arrival time and lay defibrillation before EMS arrival. Logistic regression and COX regression models were performed and adjusted for resuscitation duration to investigate the association between the type of CPR and the probability of ROSC and of 30-day mortality. Results Among 13,203 OHCAs with attempted CPR, 10,497 (79.5%) received manual CPR and in 2,405 (18.2%) mechanical CPR [Easy Pulse® in 1,102(45.8%), Autopulse® in 776 (32.3%) and LUCAS® in 521 (21.7%)]. ROSC before hospital admission was obtained in 1,712 patients (13.0%) and 762 (5.8%) were alive after 30 days. After propensity score matching two homogeneous groups of 1,946 patients each (manual and mechanical CRP) were identified. The rate of ROSC and of 30-day survival were lower in the mechanical CPR group (ROSC: 14.7% vs 24.1%; p&amp;lt;0.001; 30-day survival 6% vs 14%; p&amp;lt;0.001). The three devices showed an independent association with the probability of ROSC as compared to manual CPR [Autopulse®: OR 1.76, 95% CI (1.36-2.28) p&amp;lt;0.001; LUCAS®:OR 1.55, 95% CI (1.13-2.13), p=0.006 and Easy Pulse®:OR 0.49; 95% CI (0.37-0.65), p&amp;lt;0.001] (Figure 1A). Only Autopulse® was independently associated with 30-day mortality [AutoPulse HR 0.87, 95%CI (0.79-0.97), p=0.01; LUCAS®: HR 1.00, 95%CI (0.88-1.14), p=0.97) and Easy Pulse®: HR: 1.06, 95%CI (0.97-1.16), p=0.19] (Figure 1B). Conclusions This is the first study comparing the performance of three devices for mechanical chest compressions revealing that they differently affect the probability of ROSC and of 30-day survival.

Impact of the number of citizens officially certified for government-organized civilian cardiopulmonary resuscitation courses on the prognosis for patients with out-of-hospital cardiac arrest in Japan

Abstract Background To improve the prognosis of patients with out-of-hospital cardiac arrest (OHCA), the rate of high-quality cardiopulmonary resuscitation (CPR) and immediate use of automated external defibrillators (AEDs) by citizens must be further increased. Japanese government launched certified CPR courses for citizens throughout Japan in 1994 and the number of citizens certified on the course is increasing. However, the impact of the number of citizens officially certified for the courses on the rate of CPR implementation by citizens and the outcomes in patients with OHCA is unclear. Methods From a prospective, nationwide, population-based registry of patients with OHCA in Japan, we identified 350,444 patients from 2005 through 2020 with bystander-witnessed OHCA with 72,069 ventricular-fibrillation (VF) and the other non-VF cardiac arrests. The association between the number of citizens certified for the CPR courses and the rate of CPR implementation by citizens throughout Japan was analyzed by Poisson distribution and Cochran–Armitage test for trend. The primary outcome was survival at 1 month. The secondary outcomes were favorable neurologic outcome at 1 month. The associations between the CPR attempted by citizens [categorized into three (chest-compression-only CPR, chest compression with rescue breathing, and use of AEDs with chest compression and rescue breathing)] and outcomes were determined by multivariable mixed logistic regression analyses. Results Cumulative number of citizens certified for the CPR courses increased from 717,808 in 2005 to 34,938,322 in 2020, which reached to 27.8% of total Japanese population. Annual course receivers were also linearly increased during the period (Incidence Rate Ratios 1.03, p&amp;lt;0.001). Similarly, the rate of patients receiving CPR by citizens increased linearly from 40.6% in 2005 to 56.8% in 2020 (P for trend&amp;lt;0.001). In the multivariable mixed logistic regression analyses, higher CPR activity by citizens were significantly associated with better 1-year survival in both VF and non-VF patients even after adjusted for covariates [VF = chest compression: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.98–1.39; P =0.078; chest compression with rescue breathing: OR 1.22; 95% CI 1.02–1.49; P =0.030; use of AEDs with chest compression and rescue breathing: OR 1.54; 95% CI 1.54–1.92; P &amp;lt;0.001 vs no CPR, non-VF= chest compression: OR 1.19; 95% CI 0.76–1.87; P =0.45; chest compression with rescue breathing: OR 2.26; 95% CI 1.34–3.82; P =0.020 vs non-CPR]. Similar results were also found in neurological outcomes in 1 month. Conclusions The rate of CPR implementation by citizens throughout Japan has continuously and linearly increased in these 15 years in proportion to the increase in the number of citizens certified for the government-organized CPR courses. Higher CPR activity by citizens were significantly associated with better 1-year survival and favorable functional status in both VF and non-VF patients.

Improving outcomes from paediatric cardiac arrest in low resource setting

Abstract Introduction Both out of (OHCA) and in hospital (IHCA) pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. This is further magnified by resuscitation protocols are typically articulated from the perspective of ideal resource environment without consideration of applicability in district hospitals or non-tertiary centres. Purpose To determine clinical outcomes from both paediatric OHCA and IHCA in low-resource setting and to identify shortcomings in relation to resuscitation in these areas, possible solutions and to suggest future research priorities. Methods This was a multicenter retrospective study in a middle sized city (estimated population 390000) served by a single Emergency Medical Services (EMS) system. All records of OHCA and IHCA under 16 years old were reviewed from the Cardiac Arrest Registry from 2017 to 2022. Data collected included demographic profiles, etiology of cardiac arrest, initial cardiac rhythm, time of initiation of cardiopulmonary resuscitation (CPR) and adrenaline administration by EMS team and duration of CPR. Outcomes of interest included return of spontaneous circulation (ROSC) and survival to hospital discharge (STHD). Results From the 5-year study period, 68 children (mean age of 5.8±1.2 yrs) were included in this study. 22 (32.4%) were infants (&amp;lt;1 year old) and 7 (10.3%) were neonates (&amp;lt;28 days old). Total mortality was observed at 63.2% (n=43). Return of spontaneous circulation (ROSC) was achieved in 40 (58.8%) patients and 33.8% (n=23) survived to hospital discharge. OHCA was witnessed in 52 (83.8%) children from total OHCA and bystander CPR was delivered only in 19 (30.6%) cases. All IHCA were witnessed. Asystole was the most common (n=39) initial rhythm. A delay in initiating cardiopulmonary resuscitation (CPR) and adrenaline administration was observed in 49 cases of OHCA and 1 in IHCA. The median time from emergency call to CPR and from CPR to first adrenaline administration was 20.9±1.2 min and 2.9±1.3 min for OHCA and 0.4±0.2 min and 1.5±0.7min for IHCA [Table 1]. Longer time to CPR and adrenaline administration was associated with lower chance of achieving ROSC and STHD. Using multivariate analyses, fewer adrenaline doses (p&amp;lt;0.05), witnessed cardiac arrest (p=0.001), initial rhythm of ventricular fibrillation (p&amp;lt;0.05) and shorter CPR duration (p=0.007) were good prognostic factors for ROSC and STHD. Conclusion Outcomes from OHCA and IHCA in low resource settings are poor. Unwitnessed arrest, delays in initiation of CPR and adrenaline administration were associated with poor survival. Recognition and identification of at-risk patients, early high-quality CPR and adrenaline administration are imperative to improve mortality. Early recognition and effective resuscitation protocols for children in the community and encouraging bystander CPR should be developed collaboratively with local experts and the EMS team.

Abstract 185: Regional Oxygen Saturation and Capnography Monitoring During Resuscitation After Cardiac Arrest in a Swine Pediatric ARDS Model

Introduction: Survival and outcomes after cardiac arrest (CA) depend largely on the effectiveness of cardiopulmonary resuscitation (CPR). Traditional invasive methods of monitoring CPR can be challenging out-of-hospital and are lacking in more than 50% of in-hospital pediatric CA. Regional oxygen saturation (rSO 2 ) monitoring with Near Infrared Spectroscopy (NIRS) and volumetric capnography offers a noninvasive approach that could potentially overcome these challenges. Aim: To determine the feasibility and effectiveness of NIRS and volumetric capnography monitoring in a swine model of pediatric hypoxia induced CA. Approach: Juvenile pigs were sedated and mechanically ventilated. Mild to moderate Acute Respiratory Distress Syndrome (ARDS) was induced by continuous oleic acid infusion. Respiratory and hemodynamic variables were monitored using invasive and noninvasive (NIRS and capnography) monitoring to assess efficacy of CPR. Animals were randomized into one of the two groups: High-quality CPR (hqCPR) to achieve coronary perfusion pressure of 25-30 mmHg and low-quality CPR (lqCPR) to achieve coronary perfusion pressure of 10-15 mmHg. Trajectories over time were analyzed using regression analyses. The discriminatory ability to distinguish between groups based on trajectories were analyzed using receiver operating characteristics curve (ROC) analysis. Results: 39 animals (23±3 kg) were included in our study. In the hqCPR group, there are generally higher values for cerebral and renal rSO 2 , ETCO 2 , volume of CO 2 elimination (VCO 2 ), and carotid blood flow, compared to the lqCPR group (p&lt;0.0001). Cerebral and renal rSO 2 values increase over time, while ETCO 2 , VCO 2 , and carotid flow values decrease in the hqCPR group. Cerebral rSO2 had a ROC AUC of 0.76 (95% CI: 0.58-0.94), whereas renal rSO2 had a ROC AUC of 0.54 (95% CI: 0.22-0.87) representing nearly no discrimination ability. ETCO 2 had a ROC AUC of 0.66 (95% CI: 0.49-0.84), whereas VCO 2 had a ROC AUC of 0.62 (95% CI: 0.38-0.85). Conclusions: Higher mean cerebral rSO2 values during CPR might be used to assess quality of CPR effectiveness and provide real-time adjustments as needed. This could guide healthcare providers in optimizing CPR quality and improving outcomes for cardiac arrest patients.

Emergency Resuscitation Techniques:Airway, Breathing, and Circulation

Cardiac arrest causes cerebral anoxia, resulting in loss of consciousness within seconds and irreversible brain damage within 3-5 min. Emergency resuscitation is generally performed on patients in cardiopulmonary or near-cardiopulmonary arrest, i.e., life-threatening conditions, and requires rapid stabilization of the airway, breathing, and circulation(or "ABC")to maintain cerebral perfusion. Generally, the ABC approach represents the order of medical treatment for critically ill patients. It provides supportive care(resuscitation)after ensuring the flow of oxygen supply necessary to sustain life. The most important goal in emergency resuscitation is to ensure a secure airway, without which, resuscitation is hopeless. Clinicians should be prepared daily to avoid missing any opportunity to ensure a secure airway. Even in cardiac arrest, high-quality cardiopulmonary resuscitation is necessary to reduce the duration of cerebral anoxia. An algorithm for this high-quality cardiopulmonary resuscitation is described in this article.

Extracorporeal Cardiopulmonary Resuscitation.

Around the world, survival rates after cardiac arrest range between <14% for in-hospital (IHCA) and <10% for outof- hospital cardiac arrest (OHCA). This situation could potentially be improved by using extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR), i.e. by extracorporeal cardiopulmonary resuscitation (ECPR). A selective literature search of Pubmed and Embase using the searching string ((ECMO) OR (ECLS)) AND (ECPR)) was carried out in February 2023 to prepare an up-to-date review of published trials comparing the outcomes of ECPR with those of conventional CPR. Out of 573 initial results, 12 studies were included in this review, among them three randomized controlled trials comparing ECPR with CPR, involving a total of 420 patients. The survival rates for ECPR ranged from 20% to 43% for OHCA and 20% to 30.4% for IHCA. Most of the publications were associated with a high degree of bias and a low level of evidence. ECPR can potentially improve survival rates after cardiac arrest compared to conventional CPR when used in experienced, high-volume centers in highly selected patients (young age, initial shockable rhythm, witnessed cardiac arrest, therapy-refractory high-quality CPR). No general recommendation for the use of ECPR can be issued at present.

Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest.

Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (P=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (P<0.001). Median chest compression rate per minute was 111 and 109 (P<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (P<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (P<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (P<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.

Awareness, Knowledge, and Attitudes Regarding Cardiopulmonary Resuscitation in Case of Cardiac Arrest among the Population in the Jazan Region, Saudi Arabia

Introduction: For cardiac arrest victims, providing high-quality cardiopulmonary resuscitation (CPR) is a fundamental component of initial care, especially in out-of-hospital settings. We sought to assess the knowledge of nonmedically trained individuals about CPR in case of cardiac arrest in the population of Jazan, Saudi Arabia. Materials and Methods: A cross-sectional survey containing 22 questions was administered to individuals aged ≥ 18 years who were not health-care providers. The sample comprised residents of Jazan, Saudi Arabia. The survey included knowledge about the signs of cardiac arrest, previous experiences with CPR, knowledge of basic life support (BLS), and concerns related to CPR. Results: This study examined responses from 480 people to assess their knowledge of CPR. More than one-half were female, and only 33% were male. Only 36.04% reported having received CPR training. In the event of a family member’s cardiac arrest, more than 90% state that they would perform CPR. If a family member suffered a sudden cardiac arrest, more than 70% would call an ambulance immediately, whereas only 48% would call an ambulance if the same thing happened to a stranger. Fear of making a mistake was the most common reason for not performing CPR (70.63%). The media was the most common source of CPR training. Women were more aware of the warning signs of sudden cardiac arrest than men. Women were also more likely than men to perform CPR or call for assistance. Furthermore, women were significantly more likely than men to discontinue CPR on a sudden cardiac arrest patient for fear of stopping a working heart or being contaminated by blood or vomit. Few respondents were willing to undergo CPR training; students, homemakers, and retired people were more willing to be trained in CPR than others. Conclusion: In the Saudi Arabian province of Jazan, nonmedically trained people demonstrated a low level of CPR training and knowledge. We believe that making BLS courses available to the general public will increase CPR awareness and understanding among adults and increase survival rates in cases of sudden cardiac arrest.