Layperson Cardiopulmonary Resuscitation Research Articles

The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial.

The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. OSF Registries osf.io/egn3z; https://osf.io/egn3z. PRR1-10.2196/57280.

Reanimação cardiopulmonar por leigos – técnicas e ferramentas auxiliares: revisão integrativa

Cardiovascular diseases and the risk of cardiac arrest contribute to a significant number of deaths in Brazil. Laypeople are often the first to respond to cardiac arrest victims. This study conducts an integrative review to identify techniques and tools available for layperson cardiopulmonary resuscitation (CPR). Data were collected from PubMed, SciELO, and LILACS databases, yielding 128 articles, of which 35 were included. The analysis identifies techniques and tools that provide benefits and enhance patient survival. Telemonitoring and automated external defibrillators (AED) also play crucial roles. Techniques and tools exist to aid the general public in learning and performing CPR, but further research is required to promote their dissemination, gain acceptance within the scientific community, and ensure widespread adoption among the population.

Efficacy of distance training program for cardiopulmonary resuscitation utilizing smartphone application and home delivery system

Aim of the studyCommunity cardiopulmonary resuscitation (CPR) education is important for laypersons. However, during the COVID-19 pandemic, with social distancing, conventional face-to-face CPR training was unavailable. We developed a distance learning CPR training course (HEROS-Remote) using a smartphone application that monitors real-time chest compression quality and a home delivery collection system for mannikins. This study aimed to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality with that of conventional CPR training. MethodsWe applied layperson CPR education with HEROS-Remote and conventional education in Seoul during the COVID-19 pandemic. Both groups underwent a 2-min post-training chest compression test, and we tested non-inferiority. Chest compression depth, rate, complete recoil, and composite chest compression score was measured. Trainees completed a satisfaction survey on CPR education and delivery. The primary outcome was the mean chest compression depth. ResultsA total of 180 trainees were enrolled, with 90 assigned to each training group. Chest compression depth of HEROS-Remote training showed non-inferiority to that of conventional training (67.4 vs. 67.8, p = 0.78), as well as composite chest compression score (92.7 vs. 95.5, p = 0.16). The proportions of adequate chest compression depth, chest compression rate, and chest compressions with complete chest recoil were similar in both training sessions. In the HEROS-Remote training, 90% of the trainees were satisfied with CPR training, and 96% were satisfied with the delivery and found it convenient. ConclusionHEROS-Remote training was non-inferior to conventional CPR training in terms of chest compression quality. Distance learning CPR training using a smartphone application and mannikin delivery had high user satisfaction and was logistically feasible.

Video-assisted cardiopulmonary resuscitation: Does the camera perspective matter? A randomized, controlled simulation trial

Background Dispatcher assistance can help to save lives during layperson cardiopulmonary resuscitation during cardiac arrest. The aim of this study was to investigate the influence of different camera positions on the evaluation of cardiopulmonary resuscitation performance during video-assisted cardiopulmonary resuscitation. Methods For this randomized, controlled simulation trial, seven video sequences of cardiopulmonary resuscitation performance were recorded from three different camera positions: side, foot and head position. Video sequences showed either correct cardiopulmonary resuscitation performance or one of the six typical errors: low and high compression rate, superficial and increased compression depth, wrong hand position or incomplete release. Video sequences with different cardiopulmonary resuscitation performances and camera positions were randomly combined such that each evaluator was presented seven individual combinations of cardiopulmonary resuscitation and camera position and evaluated each cardiopulmonary resuscitation performance once. A total of 46 paramedics and 47 emergency physicians evaluated seven video sequences of cardiopulmonary resuscitation performance from different camera positions. The primary hypothesis was that there are differences in accuracy of correct assessment/error recognition depending on camera perspective. Generalized linear multi-level analyses assuming a binomial distribution and a logit link were employed to account for the dependency between each evaluator's seven ratings. Results Of 651 video sequences, cardiopulmonary resuscitation performance was evaluable in 96.8% and correctly evaluated in 74.5% over all camera positions. Cardiopulmonary resuscitation performance was classified correctly from a side perspective in 81.3%, from a foot perspective in 68.8% and from a head perspective in 73.6%, revealing a significant difference in error recognition depending on the camera perspective (p = .01). Correct cardiopulmonary resuscitation was mistakenly evaluated to be false in 46.2% over all perspectives. Conclusions Participants were able to recognize significantly more mistakes when the camera was located on the opposite side of the cardiopulmonary resuscitation provider. Foot position should be avoided in order to enable the dispatcher the best possible view to evaluating cardiopulmonary resuscitation quality.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation

Our study aimed to compare the effect of self-instruction with manikin feedback to that of instructor-led method on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skill performance. In our randomized non-inferiority trial, 64 non-healthcare providers were randomly allocated into self-instruction and instructor-led groups. Both groups watched a 27-min standardized teaching video. Participants in the self-instruction group then performed hands-on practice on the Resusci Anne QCPR with a device-driven feedback, while those in the instructor-led group practiced manikins; feedback was provided and student’s questions were answered by instructors. Outcomes were measured by blinded evaluators and SkillReporter software. The primary outcome was the pass rate. Secondary outcomes were scores of the knowledge test and items of individual skill performance. The baseline characteristics of the two groups were similar. The pass rates were 93.8% in both group (absolute difference 0%, p = 0.049 for noninferiority). The knowledge test scores were not significantly different. However, the self-instruction group performed better in some chest compression and ventilation skills, but performed worse in confirming environmental safety and checking normal breathing. There was no difference in AED skills between the two groups. Our results showed the self-instruction method is not inferior to the instructor-led method.

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.

Abstract 126: Intravenous Versus Intraosseous Epinephrine Administration for Pediatric Patients with Out-of-hospital Cardiac Arrest

Introduction: The 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation recommend intravenous (IV) or intraosseous (IO) epinephrine administration for pediatric patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether the route of epinephrine administration affects patient outcomes. Our objective was to evaluate the association between the route of epinephrine administration and survival. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry, a prospective multicenter OHCA registry from 2011 through 2015 in North America. We included pediatric patients (≤18 years) with OHCA for whom emergency medical services (EMS) providers attempted resuscitation and administered epinephrine via IV or IO. We excluded patients who received endotracheal epinephrine, received both IV and IO epinephrine, received IV epinephrine with failed IO access, and received IO epinephrine with failed IV access. The primary outcome was survival to hospital discharge. We used multivariable logistic regression and adjusted for age, sex, initial rhythm, location of arrest, witness status, receiving layperson cardiopulmonary resuscitation, 9-1-1 call to EMS arrival, and advanced airway management. We also conducted a propensity score matching analysis with the same covariates. Results: Of the eligible 831 pediatric patients with OHCA, 226 (27.2%) received IV epinephrine and 605 (72.8%) IO epinephrine. Median interval between 9-1-1 call and epinephrine administration was 16.4 minutes (interquartile range [IQR] 12.9-21.0) in IV group and 16.2 minutes (IQR 12.8-20.0) in IO group. In the logistic regression model, the adjusted odds ratio (OR) of the IO group for survival to hospital discharge was 0.99 (95% confidence interval [CI] 0.41-2.40), compared with the IV group. Similarly, in the propensity score analysis, 218 patients underwent matching with good balance (standardized differences <0.25 for all covariates) and the OR of the IO group for survival to hospital discharge was 1.00 (95% CI 0.38-2.62). Conclusions: We observed no significant difference in survival to hospital between pediatric patients with OHCA who received epinephrine via IV and IO routes.

Knowledge, Attitude, and Practice about CPR and Associated Factors among Laypersons in Dammam, Riyadh, and Jeddah

Background: Cardio-Pulmonary Resuscitation (CPR) is a crucial life-saving skill that should be taught to all members of the community. Objectives: To evaluate the knowledge, attitude, and practice about CPR and associated factors among laypersons. Materials and methods: A cross-sectional study that was done among layperson in Dammam, Riyadh, and Jeddah. Among 527 participants, 364 (69%) were male, and 163 (31%) were female. Most of our participants 472 (89.6%) did not receive CPR training while the remaining 55 (10.4%) received the CPR training. Results: Our results reveal that a significant correlation exists between education level and the CPR training received. The participants with a higher educational level are significantly higher among participants who received the training. Conclusions: Layperson CPR training rate in the study area (Dammam, Riyadh, and Jeddah) less common than in many developed countries.

Effect of real-time visual feedback device ‘Quality Cardiopulmonary Resuscitation (QCPR) Classroom’ with a metronome sound on layperson CPR training in Japan: a cluster randomized control trial

Objectives‘Quality Cardiopulmonary Resuscitation (QCPR) Classroom’ was recently introduced to provide higher-quality Cardiopulmonary Resuscitation (CPR) training. This study aimed to examine whether novel QCPR Classroom training can lead to higher chest-compression...

A machine learning based model for Out of Hospital cardiac arrest outcome classification and sensitivity analysis

BackgroundOut-of-hospital cardiac arrest (OHCA) affects nearly 400,000 people each year in the United States of which only 10% survive. Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), and machine learning (ML) techniques, we developed a model of neurological outcome prediction for OHCA in Chicago, Illinois. MethodsRescue workflow data of 2639 patients with witnessed OHCA were retrieved from Chicago’s CARES. An Embedded Fully Convolutional Network (EFCN) classification model was selected to predict the patient outcome (survival with good neurological outcomes or not) based on 27 input features with the objective of maximizing the average class sensitivity. Using this model, sensitivity analysis of intervention variables such as bystander cardiopulmonary resuscitation (CPR), targeted temperature management, and coronary angiography was conducted. ResultsThe EFCN classification model has an average class sensitivity of 0.825. Sensitivity analysis of patient outcome shows that an additional 33 patients would have survived with good neurological outcome if they had received lay person CPR in addition to CPR by emergency medical services and 88 additional patients would have survived if they had received the coronary angiography intervention. ConclusionsML modeling of the complex Chicago OHCA rescue system can predict neurologic outcomes with a reasonable level of accuracy and can be used to support intervention decisions such as CPR or coronary angiography. The discriminative ability of this ML model requires validation in external cohorts to establish generalizability.

Community Interventions to Improve Layperson Cardiopulmonary Resuscitation and Thereby Survival from Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Community Interventions to Improve Layperson Cardiopulmonary Resuscitation and Thereby Survival from Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Sex Differences in Receiving Layperson Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study in Japan.

BackgroundLayperson cardiopulmonary resuscitation (CPR) is a crucial intervention for patients with out‐of‐hospital cardiac arrest (OHCA). Although a sex disparity in receiving layperson CPR (ie, female patients were less likely to receive layperson CPR) has been reported in adults, there are few data in the pediatric population, and we therefore investigated sex differences in receiving layperson CPR in pediatric patients with OHCA.Methods and ResultsFrom the All‐Japan Utstein Registry, a prospective, nationwide, population‐based OHCA database, we included pediatric patients (≤17 years) with layperson‐witnessed OHCA from 2005 through 2015. The primary outcome was receiving layperson CPR. Patient sex was the main exposure. We fitted multivariable logistic regression models to examine associations between patient sex and receiving layperson CPR. We included a total of 4525 pediatric patients with layperson‐witnessed OHCA in this study, 1669 (36.9%) of whom were female. Female patients received layperson CPR more often than male patients (831/1669 [49.8%] versus 1336/2856 [46.8%], P=0.05). After adjustment for age, time of day of arrest, year, witnesses persons, and dispatcher CPR instruction, the sex difference in receiving layperson CPR was not significant (adjusted odds ratio for female subjects 1.14, 95% CI, 0.996‐1.31).ConclusionsIn a pediatric population, female patients with layperson‐witnessed OHCA received layperson CPR more often than male patients. After adjustment for covariates, there was no significant association between patient sex and receiving layperson CPR.

Abstract 243: Variation in Both Layperson Cardiopulmonary Resuscitation Delivery and Subsequent Survival From Sudden Cardiac Arrest Based on Neighborhood-Level Ethnic Characteristics

Background: Bystander cardiopulmonary resuscitation (B-CPR) delivery and survival from sudden cardiac arrest (SCA) varies at the neighborhood-level with poorer outcomes seen in predominantly black neighborhoods. Despite Latinos being the fastest growing minority population in the US, few studies have assessed whether the proportion of Latinos in a neighborhood is associated with B-CPR delivery and survival from SCA. Objective: We sought to assess whether there is variation in B-CPR rates and survival by neighborhood-level ethnicity. We hypothesized that neighborhoods with a higher proportion of Latinos are associated with lower B-CPR rates and lower survival. Methods: We conducted a retrospective cohort study, using data from the Resuscitation Outcomes Consortium (ROC) Epistry Registry US sites. Neighborhoods were classified by census tract, based on percentage of Latino residents: < 25%, 25%-50%, 51%-75%, or > 75%. We independently modelled the likelihood of receipt of layperson B-CPR and survival by neighborhood-level ethnicity controlling for site and patient-level confounding characteristics. Results: From 2011-2015, ROC collected 27,481 US arrest events; after excluding pediatric arrests, those witnessed by EMS, or occurred in a healthcare or institutional facility, 18,544 were included. B-CPR was administered in 37% events. Among neighborhoods with <25% Latino residents, B-CPR was administered in 39% of events, while it was administered in 27% of events among neighborhoods with >75% Latino residents. B-CPR delivery varied by patient ethnicity with Latinos being less likely to receive B-CPR compared to Whites (OR: 0.73 (CI: 0.62-0.88), p<0.01). Compared with <25% Latino neighborhoods, those in predominantly Latino neighborhoods had lower B-CPR rates (50%-75% Latino: OR: 0.79 (CI:0.69-90), p<0.01, >75% Latino: OR: 0.75 (CI: 0.62-0.90), p<0.01) and lower rates of survival (50%-75% Latino: OR: 0.81 (CI: 0.67-0.97), p=0.02, >75% Latino: OR: 0.62 (CI: 0.47-0.81), p<0.01). Conclusion: Individuals in predominantly Latino neighborhoods were less likely to receive B-CPR and had lower likelihood of survival. These findings could inform future messaging around B-CPR educational initiatives targeting largely Latino neighborhoods.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods.

IntroductionThe implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates.MethodsWe investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants.ResultsSeventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001).ConclusionA high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.

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.

42 Assessing factors affecting the quality of chest compressions during training for laypersons using a novel CPRCARD

ObjectiveThe quality of cardiopulmonary resuscitation (CPR) has been shown to affect the survival of out-of-hospital cardiac arrest cases (OHCA). There are various individual factors that can affect the quality of...

Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest.

This investigation was a retrospective study of cardiac arrest using linked data from the Cardiac Arrest Registry to Enhance Survival (CARES) database (Centers for Disease Control and Prevention [Atlanta, Georgia USA]; American Heart Association [Dallas, Texas USA]; and Emory University Department of Emergency Medicine [Atlanta, Georgia USA]) and the North Carolina (USA) Prehospital Medical Information System. Adult patients suffering a bystander-witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Logistic regression was used to calculate the adjusted odds ratio (OR) of neurological outcome as a function of PPI, while controlling for patient age, gender, and race; endotracheal intubation (ETI); shockable rhythm; layperson cardiopulmonary resuscitation (CPR); and field hypothermia. Of the 2,100 patients meeting inclusion criteria, 913 (43.5%) experienced ROSC, 618 (29.4%) survived to hospital admission, 187 (8.9%) survived to hospital discharge, and 155 (7.4%) were discharged with favorable neurological outcomes (CPC 1 or 2). Favorable neurological outcome was less likely with increasing PPI (OR=0.90; P<.01) and increasing age (OR=0.97; P<.01). Compared to patients with non-shockable rhythms, patients with shockable rhythms were more likely to have favorable neurological outcomes (OR=7.61; P<.01) as were patients receiving field hypothermia (OR=2.13; P<.01). Patient gender, non-Caucasian race, layperson CPR, and ETI were not independent predictors of favorable neurological outcome. In this evaluation, time to vasopressor administration was significantly associated with favorable neurological outcome. Among adult, witnessed, non-traumatic arrests, the odds of hospital discharge with CPC 1 or 2 declined by 10% for every one-minute delay between PSAP call-receipt and vasopressor administration. These retrospective observations support the notion of a time-dependent function of vasopressor effectiveness on favorable neurological outcome. Large, prospective studies are needed to verify this relationship. Hubble MW , Tyson C . Impact of early vasopressor administration on neurological outcomes after prolonged out-of-hospital cardiac arrest. Prehosp Disaster Med. 2017; 32(3):297-304.

The association of layperson characteristics with the quality of simulated cardiopulmonary resuscitation performance.

Few studies have examined the association of layperson characteristics with cardiopulmonary resuscitation (CPR) provision. Previous studies suggested provider characteristics, including age and gender, were associated with CPR quality, particularly chest compression (CC) depth. We sought to determine the association of subject characteristics, including age and gender with layperson CPR quality during an unannounced simulated CPR event. We hypothesized shallower CC depth in females, and older-aged subjects. As part of a larger multicenter randomized controlled trial of CPR training for cardiac patients' caregivers, CPR skills were assessed 6 months after training. We analyzed associations between subject characteristics and CC rate, CC depth and no-flow time. Each variable was analyzed independently; significant predictors determined via univariate analysis were assessed in a multivariate regression model. A total of 521 laypersons completed a 6-month CPR skills assessment and were included in the analysis. Mean age was 51.8±13.7 years, 75% were female, 57% were Caucasian. Overall, mean CC rate was 88.5±25.0 per minute, CC depth was 50.9±2.0 mm, and mean no-flow time was 15.9±2.7 sec/min. CC depth decreased significantly in subjects >62 years (P<0.001). Male subjects performed deeper CCs than female subjects (47.5±1.7 vs. 41.9±0.6, P<0.001). We found that layperson age >62 years and female gender are associated with shallower CC depth.

Death Before Disco: The Effectiveness of a Musical Metronome in Layperson Cardiopulmonary Resuscitation Training

BackgroundA novel musical memory aid has been proposed for aiding laypersons in complying with the American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines of 100 compressions per minute (cpm). ObjectiveThis study tested usefulness of such a memory aid to improve layperson long-term compliance with CPR compression rate guidelines. MethodsA prospective randomized controlled trial was conducted using CPR-untrained laypersons. Subjects received either a standard CPR educational experience (AHA Heartsaver® CPR class) or an experimental CPR educational experience (AHA Heartsaver® CPR class augmented with a musical metronome). Experimental group subjects were taught to perform compressions to the cadence of a pop music song (The Bee Gees “Stayin’ Alive”; Saturday Night Fever, The Original Movie Soundtrack; Polygram International Music, 1977) with a tempo of 100 beats/min. Compression rates, depth of compressions, and correct compressions were measured initially and upon retesting ≥6 weeks post-training. ResultsControl subjects had a higher mean compression rate both immediately (121 [standard deviation {SD} = 21] vs. 109 [SD = 15] cpm; 95% confidence interval [CI] of mean difference 4−19; p = 0.002) and at follow-up (120 [SD = 20] vs. 111 [SD = 13] cpm; 95% CI of mean difference 2−16; p = 0.014). Compression rates stratified to 100−120 cpm demonstrated no difference between groups initially (39% vs. 48%; p = 0.382), but more experimental subjects maintained these rates at follow-up (43% vs. 74%; p = 0.003). ConclusionsSubjects trained to use a musical metronome more often maintained a compression rate of 100−120 cpm at ≥6-week follow-up, suggesting the memory aid may improve long-term guideline adherence.