Lay Rescuers Research Articles

Drone-Facilitated Real-Time Video-Guided Feedback Helps to Improve the Quality of Lay Bystander Basic Life Support. A Randomized Controlled Simulation Trial

Objectives Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR. Methods We conducted a randomized controlled simulation trial. Lay rescuers performed 8 min of CPR on an objective feedback manikin. Participants were randomized to receive telephone instructions with (intervention group) or without (control group) a drone providing a visual connection with the telecommunicator after a 2-min run-in phase. Performed work (total compression depth minus total lean depth) was the primary outcome. Secondary outcomes were the proportion of effective chest compressions, average compression depth, subjective physical strain measured every 2 min, and dexterity in the nine-hole peg test after the scenario. Outcomes were compared using the t- and Mann Whitney-U tests. A two-sided p-value of <0.05 was considered significant. Results We included 27 individuals (14 (52%) female, mean age 41 ± 14 years). Performed work was greater in the intervention than in the control group (41.3 ± 7.0 vs. 33.9 ± 10.9 m; absolute difference 7.5, 95% CI 1.4 to 14.8; p = 0.046), with higher average compression depth (49 ± 7 vs. 40 ± 13 mm; p = 0.041), and higher proportions of adequate chest compressions (43 (IQR 14–60) vs. 3 (0–29) %; p = 0.041). We did not find any significant differences regarding the remaining secondary outcomes. Conclusion Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.

Lay Rescuer Equipment Preferences and Efficacy During a Simulated Drowning Event

During a drowning incident where a lifeguard is not present, a bystander – referred to as a lay rescuer - may put themselves in danger by attempting a rescue. When lay rescuers can avoid entering the water by using rescue equipment to help a drowning victim, it serves to not only help the person actively drowning, but also provides a layer of protection to a lay rescuer. This study sought to examine the following questions: (a) which pieces of rescue equipment were preferred by lay rescuers at pre-determined short and long distances, (b) do lay rescuers select appropriate rescue equipment based on the condition, (c) do lay rescuers correctly deploy their preferred rescue equipment, and (d) what factors influence rescue equipment preference. A lab-based experiment was conducted where study participants were asked to react to a simulated drowning victim using six common rescue equipment provided. The findings suggested that life rings were preferred rescue equipment by lay rescuers and should be provided in unguarded aquatic environments.

Early intranasal medication administration in out-of-hospital cardiac arrest: Two randomized simulation trials.

Intranasal medications have been proposed as adjuncts to out-of-hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands-only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group. Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1s, 95% CI: 14.9, 73.3), which persisted after adjustment (p=0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2cpm, mean diff. -9.1cpm, 95% CI -16.6, -1.6) and CCF (INMA 62.4%vs control 69.8%, mean diff. -7.5%, 95% CI -12.0, -2.9). Among FRs, we found no significant CPR2 delays (mean diff. -2.1s, 95% CI -15.9, 11.7), which persisted after adjustment (p=0.704), or difference in quality (CCR INMA 115.5cpm vs control 120.8cpm, mean diff. -5.3cpm, 95% CI -12.6, 2.0; CCF INMA 79.6%vs control 81.2% mean diff. -1.6%, 95% CI -7.4, 4.3%). INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.

Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study.

This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes. HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively. This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.

Chain of Survival - Important Role of General Citizens as Lay Rescuers.

Chain of Survival - Important Role of General Citizens as Lay Rescuers.

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

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

Abstract 311: Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations

Introduction: Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. Aim: We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). Methods: We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LR and FR. LR received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer’s recommendations and distance to anatomical landmarks (mid, nipple, and naval lines). Incorrect AP placement was defined as more than 6 cm medial or 10 cm inferior. Incorrect LP placement was defined as more than 6 cm superior, 9 cm inferior, or 10 cm medial. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (&lt; 1 year) with AED application for FR using Chi-square tests. Results: LR correctly placed the AP in 30/38 (79%) and the LP 30/38 (79%) simulations. Application did not differ significantly based on previous CPR training (AP p= .187, LP p=.578). The most common incorrect placement was too low for both AP (5/8, 63%) and LP (4/8, 50%). FRs applied the AP correctly in 31/36 (86%) and the LP in 22/36 (61%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p=.29, LP p=.563). The most common incorrect placement was too low for both AP (5/5, 100%) and LP (12/14, 86%). Conclusion: Both LRs and FRs may not apply AEDs per manufacturer’s recommendations. Further research is needed to improve instructions and follow-up training to ensure appropriate placement of AEDs, and to understand how improper AED placement impacts the accuracy of rhythm analysis and defibrillation success.

Abstract 290: Initial Engagement in a Novel Online Support Community for Cardiac Arrest Survivors, Co-Survivors, Lay Rescuers, and Advocates

Background: Cardiac arrest survivors often experience physical, cognitive, emotional, and social challenges that can linger for years. Co-survivors and lay rescuers can also experience distress. In 2023, Sudden Cardiac Arrest Foundation (SCAF) created the Cardiac Arrest Survivor Alliance™ (CASA), an online community to support these individuals. CASA offers evidence-based information about common challenges post-arrest, easy connection with peers, access to experts, and pathways to further clinical support. To measure early dissemination, we examined CASA’s community engagement and growth through the first 5 months. Methods: We built CASA using Mighty Networks (MN), assembled a leadership team including researchers and clinicians with expertise in post-resuscitation quality of life, and launched the community in mid-January 2023. We recruited members through SCAF’s Survivor Network and outreach via its website, newsletters, and social media. We obtained analytic reports to evaluate engagement and growth of CASA during the first 5 months of operation. Results: By mid-June 2023, there were 868 members from the U.S. and 21 other countries. Based on preliminary data, approximately 75% of members are survivors. Initial growth resulted from SCAF outreach and is continuing organically through internet searches and member outreach. During the 5-month period, there were: 6,829 contributions (sum of actions taken by hosts, moderators and members including posts, “cheers,” comments, chat messages, direct [private] messages [DMs], and RSVPs), 858 active members (total members who visited during the 5-month period), and 376 unique members providing contributions. Members are not only engaging publicly, but also privately; 344 members (40%) have sent 1,944 DMs. MN considers communities to be successful if 15% or more members send DMs. CASA also provides monthly webinars with guided discussions led by experts. Attendance has ranged from 22 to 47 participants. Conclusion: In the 5 months since its launch, the CASA community is engaged and continually growing. Future plans include providing additional evidence-based content, outreach to hospitals and targeted healthcare professionals, and collaboration with program partners to grow the CASA community.

Investigation of the Effect of Using a Metronome or Song on the Lay Rescuers' Quality of Chest Compressions

Introduction: This study aimed to determine the quality of chest compressions performed by lay rescuers assisted by a healthcare worker over the telephone and investigate the effect of metronome use or the Stayin’ Alive song on the quality of these chest compressions.&#x0D; Material and Method: This study was conducted prospectively at the emergency department of a tertiary hospital. The lay rescuers were assisted by an emergency medicine specialist over the telephone to perform chest compressions using the CPR Lilly PRO+ simulator. Three groups were formed, and the same participants performed three cycles of chest compressions over the telephone for two minutes first without any external stimulus (Group 1), then using a metronome as an external stimulus (Group 2), and finally by listening to the Stayin’ Alive song as another external stimulus (Group 3). The obtained data were analyzed with IBM SPSS v. 23.0.&#x0D; Results: There was no statistically significant difference between the three groups in terms of the target number of chest compressions (p=0.404). However, the compression depth and chest compression fraction statistically significantly differed between the groups (p

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study.

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

The immediate effect of deliberate practice and real-time feedback on high-quality CPR training in intern doctors, acute care providers, and lay rescuers

The quality of cardiopulmonary resuscitation (CPR) is the main determinant of survival in cardiac arrest, so high-quality CPR (HQ-CPR) from bystanders is essential. The best instructional model for HQ-CPR performed by bystanders remains under investigation, and an instructional model’s effect on various learner types is unknown. This study examined the immediate effect of a brief, blended instructional design that combines deliberate practice (DP) with real-time feedback (RTF) on the booster training of intern doctors (IDs) and acute care providers (ACPs) as well as on the skills acquisition training of lay rescuers (LRs). This cohort crossover study was conducted in a university-affiliated hospital in January 2020. Just-in-time training on HQ-CPR that featured a popular song was provided to IDs (n = 24), ACPs (n = 29), LRs (n = 25); groups performed one-minute cardiac compressions twice, without RTF and with verbal coaching, followed by debriefing, and then with only RTF. The impact of RTF on depth, rate, compression quality (CQ), and recoil was assessed. RTF significantly improved depth, rate, CQ, and recoil (p &lt; 0.001). Among the LRs, the depth was 0.2 millimeters below the lower cutoff. Without RTF, the previously trained IDs and ACPs tended to perform inadequately faster and deeper compressions, while the untrained LRs performed slower, shallow compressions. DP combined with RTF yielded a significant immediate effect on the HQ-CPR training outcomes of all learner types.

Experiences and Psychological Influences in Lay Rescuers Performing Bystander Cardiopulmonary Resuscitation: A Qualitative Study.

Bystander-initiated cardiopulmonary resuscitation (CPR) and the use of automated external defibrillation (AED) is pivotal in the community chain of survival, but little is known regarding the bystander experience of performing CPR and AED, and their psychological infl uence from the incidents in the Asian community. This qualitative study was conducted to explore the experiences of lay rescuers who had performed CPR and AED in public locations in Taiwan. Lay rescuers who had provided initial CPR and defi brillation with AED in public locations across Taiwan in 2015 were selectively recruited from Taiwan Public AED Registry for a semi-structured interview. Nine participants were included in the study, and event-to-interview duration was within 1 year (n = 4) and 1-2 years (n = 5). The major fi ndings from the study were: (1) the lay rescuers possessed helping traits and high motivation; (2) the lay rescuers reported certain aspects of rescue reality that differed much from prior training and expectations, including diffi culty in the depth of chest compression, and uncertainties in real emergency situations; (3) the lay rescuers gained positive personal fulfi llment in sharing their experience and receiving positive feedback from others, and were willing to help next time, although they experienced a short-term negative psychological impact from the event. This study provides valuable information on strategies to increase layperson CPR rates and effectiveness in CPR training. Measures should be taken to increase layperson's confi dence and situation awareness, reduce training-reality discrepancy, build up a support system to avoid negative psychological effects, and prepare lay rescuers for the next resuscitation.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights

Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.

Abstract 482: Differences in Ground Reaction Forces and Chest Compression Release Velocity in Professional and Lay Rescuers With and Without the Use of Real-Time CPR Feedback

Purpose: Chest compression release velocity (CCRV) has been associated with survival and favorable neurological outcome after cardiac resuscitation. Both complete chest release and high CCRV contribute to improved venous return during CPR. Differences in compression forces delivered by professional and lay rescuers are reported, which may contribute to differences in CCRV. The aim of this pilot study was to investigate differences in ground reaction force (GRF) and CCRV between professional and lay rescuers during CPR performed on a manikin with and without real-time feedback. Methods: Professional (n = 5) and lay rescuers (n = 11) performed two minutes of continuous compressions on a manikin positioned over a force plate for two trials. CPR feedback provided by a defibrillator was disabled in the first trial and enabled in the second. CPR pads containing an accelerometer were used to calculate individual compression characteristics. Relative maximum and minimum GRFs were calculated for each compression cycle and averaged over each trial. Paired and independent sample t tests and Pearson correlations were conducted in STATA 15.1. Results: CCRV was higher in professionals vs. lay rescuers with feedback disabled and enabled ( p &lt;0.05). Professionals had greater maximal and lower minimum forces than lay rescuers without feedback ( p &lt;0.05), though there were no differences between groups with feedback enabled (Table 1). CCRV was associated with minimum force (r = -0.63, p &lt;0.01) and force range (r = 0.78, p &lt;0.01) in all rescuers. Analysis of GRFs by CCRV for all rescuers indicated lower force minimum (9.71 + 3.16 N, p &lt;0.05) with CCRV &gt;400 mm/s in comparison to CCRV 300-400 mm/s (39.73 + 8.91 N) and CCRV 200-300 mm/s (63.82 + 16.98 N). Conclusions: CPR feedback attenuated differences in GRF between professional and lay rescuers. CCRV was greater in professionals and was associated with measures of GRF, and thus may serve as an indicator of both velocity and amount of chest release.

Stop the Bleed Training: Rescuer Skills, Knowledge, and Attitudes of Hemorrhage Control Techniques

BackgroundBystanders play a significant role in the immediate management of life-threatening hemorrhage. The Stop the Bleed (STB) program was designed to train lay rescuers (LRs) to identify and control life-threatening bleeding. The aim of this study was to evaluate the efficacy of STB training for rescuers from different backgrounds. We hypothesized that STB training would be appropriate to increase skills and knowledge of bleeding control techniques for all providers, regardless of level of medical training. Study designCourse participants anonymously self-reported confidence in six major areas. A five-point Likert scale was used to quantitate participant's self-reported performance. Results were stratified into medical rescuers (MR) and LRs. Students' ability to perform STB skills were objectively assessed using an internally validated 15-point objective assessment tool. Data were pooled and analyzed using Student's t-test and chi-Squared test with P < 0.05 considered significant. Results are presented as average with standard deviation (SD) unless otherwise stated. ResultsA total of 1974 participants were included in the study. Precourse confidence was lowest for both groups in management of active severe bleeding and ability to pack a bleeding wound. Postcourse confidence improved significantly for both groups in all 6 core areas measured (P < 0.001). The most significant increases were reported in the two previous areas of lowest precourse confidence-management of active severe bleeding—LRs 2.0 (SD 1.2) versus 4.2 (SD 0.9) and MRs 2.6 (SD 1.4) versus 4.6 (SD 0.6), P < 0.001—and ability to pack a bleeding wound—LR 2.1 (SD 1.3) versus 4.4 (SD 0.8) and MR 2.7 (SD 1.3) versus 4.7 (SD 0.05), P < 0.001. Objective assessment of LR skills at the end of the course demonstrated combined 99.3% proficiency on postcourse objective assessments. ConclusionsThis study provides quantitative evidence that Stop the Bleed training is effective, with both LRs and MRs demonstrating improved confidence and skill proficiency after a 1-h course. Future program development should focus on building a pool of instructors, continued training of LRs, and determining how often skills should be recertified.

Abstract 01: Dispatching Lay Rescuers Through a Smartphone Application is Associated With Increased Bystander Defibrillation in Out-of-Hospital Cardiac Arrest

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) is dependent on early defibrillation. To increase bystander defibrillation in OHCAs, a first-responder program dispatching lay rescuers (Heart Runners) through a smartphone application (Heart Runner-app) was implemented in the Capital Region of Denmark. We investigated the proportion of Heart Runners arriving prior to the Emergency Medical Services (EMS) and rates of bystander defibrillation. Methods: The Capital Region of Denmark comprises 1.8 mil. inhabitants and 19,048 Heart Runners were registered. In cases of suspected OHCA, the Heart Runner-app was activated by the Emergency Medical Dispatch Center. Up to 20 Heart Runners &lt; 1.8 km from the OHCA were dispatched to either start cardiopulmonary resuscitation (CPR) or to retrieve and use a publicly accessible automated external defibrillator (AED). Through an electronic survey, Heart Runners reported if they arrived before EMS and if they applied an AED. OHCAs where at least one Heart Runner arrived before EMS were compared with OHCAs where EMS arrived first. All OHCAs from September 2017 to May 2018, where Heart Runners had been dispatched, were included. Results: Of 399 EMS treated OHCAs, 78% (n=313/399) had a matching survey. A Heart Runner arrived before EMS in 47% (n=147/313) of the cases, and applied an AED in 41% (n=61/147) of these cases. Rate of bystander defibrillation was 2.5-fold higher compared to cases where the EMS arrived first (Table 1). Conclusions: By activation of the Heart Runner-app, Heart Runners arrived prior to EMS in nearly half of all the OHCA cases. Bystander defibrillation rate was significantly higher when Heart Runners arrived prior to EMS.

Critical Assessment of Stop the Bleed: Skills for Both Lay and Medical Rescuers

Critical Assessment of Stop the Bleed: Skills for Both Lay and Medical Rescuers

Abstract MP73: Emergency Call First Strategy versus Bystander Cardiopulmonary Resuscitation First Strategy for Out-of-Hospital Cardiac Arrest

Introduction: Lay rescuers have a crucial role in successful cardiopulmonary resuscitation (CPR), specifically the first three links in the chain of survival, for out-of-hospital cardiac arrest (OHCA). However, randomized controlled trials on the priority of emergency call (Call first) versus bystander CPR (CPR first) do not exist, and comparative data are very limited. We aimed to assess the association between the priority of bystander’s action (Call first vs. CPR first) and neurologic outcome after OHCA. Methods: This nationwide population-based study of patients who experienced OHCA from January 2005 to December 2014 was based on the data from the Japanese government-managed registry of OHCA. Patients provided bystander’s action (both emergency call and bystander CPR) within 1 minute of witness were included, and Call first strategy was compared with CPR first strategy. The primary outcome was one-month neurologically favorable survival, defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1(good performance) or 2(moderate disability). The secondary outcomes were prehospital return of spontaneous circulation (ROSC) and one-month overall survival. Results: A total of 25,840 patients were included; 4,430 (17.1%) were treated with Call first approach, and 21,410 (82.9%) were treated with CPR first approach. Among total cohort, 2,696 (10.4%) survived with neurologically favorable status one month after OHCA. In the propensity score-matched cohort, one-month neurologically favorable survival was lower among Call first group compared with CPR first group: 364 of 4,430 patients (8.2%) vs. 457 of 4,430 patients (10.3%), respectively (Risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70-0.91). Similar associations were observed for one-month overall survival (RR, 0.90; 95%CI, 0.82-0.99), although there were no significant differences in prehospital ROSC (RR, 0.94; 95%CI, 0.86-1.02) between the Call first and CPR first groups. In subgroup analyses, the association between delayed bystander CPR and worse neurological outcome did not change regardless of subgroup characteristics. Conclusions: In witnessed OHCA, Call first approach was associated with a decreased chance of one-month neurologically favorable survival compared with CPR first approach. These observational findings warrant a randomized clinical trial to determine the priority of emergency call or bystander CPR for OHCA.

The Construction of Lay Rescuers in Bystander CPR Classes

There are many situations in society and life in which the body is expected to play an important role for the acquisition of particular skills. This article reports on a study of such a situation, namely when information about first aid and how to perform cardiopulmonary resuscitation (CRP) is mediated to nonmedical professionals. The aim of the article is to tease out how different modes of informing feature in first aid and CPR classes for the lay public in order to transform participants in such classes into CPR-trained lay rescuers ready to intervene in cases of what is suspected to be cardiac arrests. The understanding of the role of the body in information-related activities is based on a practice-theoretical approach. How information figures in the practice of first aid and CPR training is also discussed in light of Foucault’s notions of biopolitics and self-technologies. The practice-theoretical approach illuminates how bodies are en-twined in information activities, and the notions of biopolitics and self-technology illuminate how the practice of bystander CPR training instantiates control through the different kinds of informing activities that occur in classes. This study is based on material gathered through observations in bystander CPR classes.