Life Support Program Research Articles

Potential Development in Knowledge, Chest Compression Skill, Automated External Defibrillator Skill and Basic Life Support for Thai Village Health Volunteer

Background and objectives: Currently, emergencies from complications, congenital disease, or physical pathology, such as out-of-hospital cardiac arrest (OHCA), are important causes of death and hospital admission, and sudden cardiac arrest occurs until the heart stops working immediately. This study aims to To examine the results of repeated measurements with Qualitative Confirmation of results, knowledge, understanding, chest compression skills, use of AEDs, and basic life support for village health volunteers (VHV). Methods: This mixed-method. Phase 1 quasi-experimental research. The sample group consisted of 30 Village Health Volunteers (VHV) selected using a simple random sampling method. The tool used in this research was the basic life support program that seduces a group process. Knowledge assessment form and basic life support skills. Data collection was performed by repeated measurement six times; Phase 2, qualitative research by discussing Basic life support program of Village Health Volunteers (VHV) that participated in the quantitative research program. After the 6th follow-up repeat measurement for one month, the sample was selected randomly from 10 participants in the program in phase 1. Quantitative data were analyzed using descriptive statistics, one-way analysis ANOVA with repeated measures, and statistical data. Qualitative data were analyzed using content analysis. Results: The findings of the quantitative study showed that Village Health Volunteer (VHV) had knowledge scores on patient assessment and environment, chest compression, use of AED, and basic life support. From each measurement, there was a better direction statistically significant at the qualitative level of 0.01. Conclusion: Basic life support program using group processes can develop potential and increase confidence in knowledge and understanding, skills in patient assessment and environment, chest compression, use of AED, and basic life support. Therefore, knowledge, understanding, and basic life support skills should be regularly and continuously reviewed to ensure resuscitation efficiency. Word count: 5,578 words, excluding references. Funding Statement: The study was supported by a grant from Non Sung Hospital, Nakhon Ratchasima Province, Thailand. Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Author Contributions: AV and PC contributed to the design and implementation of the research, JK and KV to the analysis of the results, and TB and TP to the writing of the manuscript.

Readiness of University Students in Riyadh to Participate in Basic Life Support Programs: A Cross-Sectional Study.

Introduction Out-of-hospital cardiac arrest is one of the greatest causes of death in the world. When basic life support (BLS) techniques are performed rapidly, the odds of survival increase. The aim of this research is to assess the university students' preparation and knowledge level regarding their interest in participating in BLS. Methods A cross-sectional study using an online self-administered questionnaire was conducted between January 20 andMarch 20, 2022. The questionnaire addressed awareness about BLS, willingness to participate in such courses, perceived barriers and incentives, and course uptake, in addition to the sociodemographic profile of participants. Logistic regression analysis was used to identify the factors significantly associated with the willingness to participate in BLS courses and the associations are reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results A total of 1,546 students completed the questionnaire; almost half of them (n=761, 49.2%) were aged 17 to 21 and the majority were females (n=1,132, 73.2%). Only one-third of the population had heard about BLS (n=519, 33.6%), 27.1% (n=419) recognized where to register for BLS training, and 20.3% (n=314) had taken a BLS course. Most participants (n=1,081, 69.9%) demonstrated a low level of awareness. Conversely, a substantial portion (n=1,204, 77.9%) expressed a personal interest in undertaking the course. It was observed that participants who are affiliated with healthcare specialties (AOR = 5.96, 95% CI= 4.66-7.63, p<0.05) exhibited greater knowledge about BLS, while females (OR = 2.49, 95% CI= 1.52-4.08, p<0.05) and those in healthcare specialties (OR = 2.23, 95% CI= 1.29-3.82, p<0.05) displayed a notably higher inclination to enroll in BLS courses compared to their counterparts. Conclusion Despite the limited awareness of BLS among university students, there is a strong willingness to engage in BLS courses. It is crucial to motivate students to partake in these courses and emphasize the availability of accredited centers for their education institutes.

A Comparative Analysis of ChatGPT, ChatGPT-4, and Google Bard Performances at the Advanced Burn Life Support Exam.

Artificial intelligence and large language models (LLMs) have recently gained attention as promising tools in various healthcare domains, offering potential benefits in clinical decision-making, medical education, and research. The Advanced Burn Life Support (ABLS) program is a didactic initiative endorsed by the American Burn Association, aiming to provide knowledge on the immediate care of severely burn patients. The aim of the study was to compare the performance of three LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) on the ABLS exam. The ABLS exam consists of 50 questions with 5 multiple-choice answers. The passing threshold is 80% of correct answers. The 3 LLMs were queried with the 50 questions included in the latest version of the ABLS exam, on July 18th, 2023. ChatGPT-3.5 scored 86% (43 out of 50), ChatGPT-4 scored 90% (45 out of 50), and Bard scored 70% (35 out of 50). No difference was measured between ChatGPT-3.5 and ChatGPT-4 (P = .538) and between ChatGPT-3.5 and Bard (P = .054), despite the borderline P-value. ChatGPT-4 performed significantly better than Bard (P = .012). Out of the 50 questions, 78% (n = 39) were direct questions, while 12% (n = 11) were presented as clinical scenarios. No difference in the rate of wrong answers was found based on the type of question for the 3 LLMs. ChatGPT-3.5 and ChatGPT-4 demonstrated high accuracy at the ABLS exam and outperformed Google Bard. However, the potential multiple applications of LLMs in emergency burn and trauma care necessitate appropriate surveillance and most likely should represent a tool to complement human cognition.

시뮬레이션 기반 병원 전 외상소생술 교육이 응급구조학과 대학생의 지식, 비판적 사고성향 및 자신감에 미치는 효과

시뮬레이션 기반 병원 전 외상소생술 교육이 응급구조학과 대학생의 지식, 비판적 사고성향 및 자신감에 미치는 효과

Evaluating the effectiveness of the pre‑hospital trauma life support (PHTLS) program for the management of trauma patients in the pre-hospital emergency based on Kirkpatrick’s evaluation model

BackgroundPre-hospital trauma life support (PHTLS) training courses have been developed and widely adopted to enhance the proficiency of pre-hospital personnel in handling trauma patients. The objective of this study was to assess the effectiveness of the educational program for managing trauma patients in the pre-hospital emergency setting, utilizing Kirkpatrick’s educational evaluation model.MethodsThis is an observational approach, consisting of four sub-studies. The PHTLS course was conducted over a 2-day period, encompassing both theoretical and practical components. For this study, we selected pre-hospital personnel from three emergency aid stations using a convenient sampling method. These personnel underwent their first-ever PHTLS course training, and we subsequently analyzed the effectiveness of the training program using Kirkpatrick’s four levels of evaluation: satisfaction, learning, behavior, and results.ResultsThe study conducted on Kirkpatrick’s first-level analysis revealed that participants expressed a high level of satisfaction with the quality of all aspects of the course. Moving on to the second and third levels, namely learning and behavior, significant improvements were observed in the average scores of various skills that were examined both immediately after the course and 2 months later (P < 0.05). However, when it comes to the fourth level and the impact of the course on indicators such as mortality rate and permanent disability, no significant changes were observed even after an average of 3 months since the course was introduced.ConclusionThe implementation of PHTLS has been linked to the enhancement of participants’ skills in treating trauma patients, leading to the application of acquired knowledge in real-life scenarios and a positive change in participants’ behavior. The evaluation of PHTLS courses in Iran, as in other countries, highlights the need for specialized training in pre-hospital trauma care. To ensure the continued effectiveness of the PHTLS course, it is advisable for managers and policymakers to encourage regular participation of PHTLS employees in the program.

*SMARTSIM* A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation.

Simulations are an integral part of paramedic education. Technological advancements have introduced three-dimensional virtual reality patient simulations (3DVRS), offering a low-cost, accessible alternative. This study compares the impact of 3DVRS and traditional simulation on paramedic students. Students selected from a convenience sample of 11 cohorts in 10 accredited programs distributed across the United States were allocated to 2 groups using a stratified random sampling. One group received simulations via 3DVRS, the second used traditional in-person simulation. Students were exposed to 6 scenarios over 2h from the National Association of Emergency Medical Technicians (NAEMT) Advanced Medical Life Support (AMLS) program. Altered mental status scenarios were selected a priori by the research team containing approximately 30 potential differential diagnoses. A 50-item posttest was administered using validated cognitive items provided by Fisdap. A multicenter prospective randomized trial of 174 paramedic students was undertaken from April until August of 2022. The traditional simulation group was comprised of 88 students and the 3DVRS group had 86 students. A Mann-Whitney U test (U=4064.5, n 1=88, n 2=86, p=0.396) detected no statistical difference between two distributions or median exam score (70%), the range of values and interquartile range (IQR) for both groups: TS IQR=64-75 (range, 32-82); 3DVRS IQR=64-76 (range, 34-86). No difference in exam scores using 3DVRS versus traditional simulation was detected. Paramedic programs may have an effective new option when incorporating simulation with 3DVRS, potentially reducing financial and real-estate resources required with in-person simulations. Larger studies are needed to truly evaluate the impact and usability of virtual reality on paramedic education.

Designing and maintaining a rescue extracorporeal life support program: A holistic simulation approach.

Rescue Extracorporeal Life Support Programs based at non-cardiac surgery centers have unique needs to be able to ensure successful outcomes despite low patient volumes. In this paper we describe the important role simulation had in each stage of development, implementation, and maintenance of our pediatric Rescue ECLS Program. Systems-focused simulations were used to develop robust workflows, processes, and bundles. Simulation-based education targeted the acquisition and maintenance of clinical skills for individual team members, bringing together a multidisciplinary team of local clinicians who do not routinely perform pediatric cannulation related tasks. Translational simulation ensured continued improvement by addressing adverse events or latent safety threats observed during system-focused or educational simulations. Realism of all simulations was our priority, and was achieved through in situ simulations, participation of multidisciplinary teams, use of real equipment and medical supplies, and use of a high-fidelity cannulation manikin. This holistic simulation approach allowed us to overcome the barriers to high quality care, and maintain outcomes comparable to high volume centers. A similar approach can help other centers design simulation for their own Rescue ECLS Program, and can be translated to other high-risk and high-acuity critical care programs.

465 Basic Life Support Program in Catalan schools as a curricular content

465 Basic Life Support Program in Catalan schools as a curricular content

Basic life support awareness among medical undergraduate students in Syria, Iraq, and Jordan: a multicenter cross-sectional study

Background and aimsBasic life support (BLS) training rates vary widely worldwide, and there is a general scarcity of surveys that assess students’ knowledge and awareness of BLS in middle eastern nations. This study aims to evaluate medical students’ knowledge and awareness towards basic life support.MethodsA cross-sectional study, using an online web-based questionnaire, assessing BLS awareness and knowledge, was conducted from 3 to 30 November 2021. The study included 2114 medical students from Syria, Iraq, and Jordan. The questionnaire consisted of three sections: demographic baseline characteristics, knowledge about BLS, and ability to apply basic life support. A binominal logistic regression was done between the total score and other demographic characteristics to determine if we could predict the research sample's appropriate knowledge of BLS level.ResultsThere was a moderate knowledge of BLS and cardiopulmonary resuscitation (CPR) skills among participating students with an average score of 19.67 (0–34). Seventy-eight of the participants (1656) stated that they have not attended a basic life support course. There was a significant difference between the participants from different countries, where the mean score in Syria, Jordan, and Iraq was 18.3, 24.3, and 18.8, respectively (p < 0.05). Considering the level of knowledge, 18.3%, 72.8%, and 8.9% of the participants had a high, intermediate, and low level, respectively. Furthermore, students who took a BLS course had a higher level of knowledge than those who did not, with an odds ratio of 5.168 (p value < 0.0001).ConclusionThe overall knowledge of medical students’ basic life support knowledge is insufficient and need to be greatly improved. According to this study, previous participation in basic life support training had a positive effect on knowledge level. As a result, universities must establish basic life support programs as quickly as possible.

Assessment of batch culture conditions for cyanobacterial propagation for a bioreactor in space

One important point in human space exploration is the reliable air, water and food production for the space crew, less dependent from cargo supply. Bioregenerative life support systems aim to overcome this challenge. The life support program MELiSSA of the European Space Agency uses the cyanobacterium Limnospira indica for air revitalization and food production. In the Space flight experiments ArtEMISS-B and -C, L. indica is tested on the International Space Station. In this study we elucidate which conditions are most favorable for cell propagation from inoculum to a full culture in space to enable a high final biomass concentration, with high pigment composition for an efficient bioprocess. We found that lower light intensities (36–75 µmol photons m-2 s-1) show higher maximum biomass densities and higher pigment contents than cultures grown above 100 µmol photons m-2 s-1. 36 μmol photons m-2 s-1 resulted in maximum biomass concentrations of 3.36 ± 0.15 g L-1 (23 °C), while cultures grown at 140 µmol photons m-2 s-1 only achieved concentrations of 0.82 ± 0.10 g L-1 (25°C) (−75.8%). Colder temperatures (21°C–25°C) showed a negative effect on the pigment content. At 36 µmol photons m-2 s-1, a temperature of 30°C gave a phycocyanin concentration of 0.122 ± 0.014 g g DW-1 and 23°C resulted in 0.030 ± 0.003 g g DW-1 (−75.4%). In conclusion, a low light intensity (36–80 µmol photons m-2 s-1) in combination with warm temperature (30°C–34°C) is optimal to obtain cultures with high pigment contents and high biomass concentrations in a batch culture.

How Does the Frequency of Eating-Alone among Older People in Korea Affect Their Health and Dietary Behavior?

This study examined the relationship between general population characteristics and diet-related factors pertaining to eating alone for older adults (65 years and older) in Korea. This study used the Korea National Health and Nutrition Examination Survey (KNHANES), 2016–2020, and the target population was 7037 Koreans aged 65 years or older who participated in the nutritional survey and health interview. Eating alone variables were classified as follows. Eating together all day means “eating together”, eating only one meal a day means “1/day”, eating two meals a day alone means “2/day”, and “3/day” means eating three meals a day alone. The main results are as follows. The rate of moderate or severe food insecurity was 3.41% in the “eating together” group to 7.86% in the “3/day” group, which was 4.45% higher in the “3/day” group. Fruit + vegetable intake among food intake lowered by about 35 g from 301.2 g in the “eating together” group to 266.2 g in the “3 day” group. In addition, as a result of analyzing the prevalence of depression using the PHQ-9 score, the “3/day” group had a 1.775 to 2.464 times higher risk of depression than the “eating together” group. Finally, EQ-5D variables and quality of life scores were significantly lowered from the “eating together” group to the “3/day” group. Overall, higher frequency of eating alone was associated with food safety, essential food intake, and quality of life. Based on these results, it is thought that a dietary life support program such as the eating together program is necessary to improve the quality of life of the older people who eat alone.

An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years.

We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations-including V-A, V-V, and ECPR modalities-demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.

Experience in implementing a program for basic life support and available automated defibrillation in a cancer center

Unified approaches to ensuring the chain of survival can improve the patient’s prognosis both in out-of-hospital and in-hospital cardiac arrest.Aim. To discuss practical issues of introducing a program for the availability of automated external defibrillation in a cancer center.Material and methods. For four years, our healthcare facility has been implementing a training program for basic and advanced life support according to the European Resuscitation Council standards, combined with the creation and development of an infrastructure for the availability of automatic defibrillation. A roadmap and infrastructure were developed for the project implementation.Results. In 2018-2022, 229 employees (114 doctors, 85 nurses and 30 nonmedical workers) were trained under the basic life support program. Fifteen defibrillators were placed in various units. During the specified period, first aid in case of sudden cardiac arrest using an automated external defibrillator before the resuscitation team arrival was independently provided by doctors and nurses of departments three times. To implement training in the continuous education system, the curriculum has passed the examination and accreditation in the edu. rosminzdrav system.Conclusion. The development and implementation of such initiatives requires significant organizational and methodological work, including continuous education system. However, in our opinion, this is an extremely useful tool for improving the safety and quality of medical care.

Effects of a Designated Ambulance Team Response on Prehospital Return of Spontaneous Circulation and Advanced Cardiac Life Support of Out-of-Hospital Cardiac Arrest: A Nationwide Natural Experimental Study

Objectives This study aimed to investigate the effects of adding advanced cardiac life support (ACLS) training to an existing basic life support program and the operation of a designated team response for patients with out-of-hospital cardiac arrest (OHCA) on prehospital return of spontaneous circulation (ROSC) and ACLS management. Methods A natural experimental study was conducted for emergency medical service (EMS)-treated adult patients with OHCA in 2020. In 2019, a quarter of the EMS clinicians were trained in a 3-day ACLS courses, and they were designated to be dispatched first in suspected OHCA. Some were dispatched only to major emergencies, such as OHCA and myocardial infarction (dedicated team), while others were dispatched to all emergencies with priority to major ones (non-dedicated team). The exposure was the ambulance response type: dedicated, non-dedicated, and basic teams (others). The primary outcome was prehospital ROSC. The secondary outcomes were prehospital ACLS (advanced airway management and intravenous access). A multivariable logistic regression analysis was conducted to investigate the effect of ambulance response type on study outcomes. Results Among 23,512 eligible patients with OHCA, 54.8% (12,874) were treated by the basic team, 36.5% (8,580) by the non-dedicated ACLS team, and 8.8% (2,058) were treated by the dedicated ACLS team. Prehospital ROSC was greater for the designated team than for the basic team (dedicated ACLS team 13.8%, non-dedicated ACLS team 11.3%, and basic team 6.7%) (p < 0.01). In the final logistic regression analysis, compared with the basic team, the designated ACLS team was associated with a higher probability of prehospital ROSC (AOR (95% CIs), 1.88 (1.68–2.09) compared to the non-dedicated ACLS team, and 2.46 (2.09-2.90) compared to the dedicated ACLS team), prehospital advanced airway management (1.72 (1.57-1.87) and 1.73 (1.48-2.03), respectively), and intravenous access (2.29 (2.16-2.43) and 2.76 (2.50-3.04), respectively). Conclusion Additional ACLS training and operation of a designated OHCA team response were associated with higher rates of prehospital ROSC and prehospital ACLS provision. However, further research is needed to find the optimal operation for EMS to improve survival outcomes.

The “ABC SAVES LIVES”: A Schoolteacher-Led Basic Life Support Program in Navarra, Spain

To implement a teacher-led basic life education program in schools. Design thinking methodology was used to develop a comprehensive program to make teachers competent and confident in the delivery of Basic Life Support (BLS), and then to independently implement teaching programs in their school’s community. Specific teaching material and training manikins were provided by the “ABC Save Lives association.” Training was open to all but focused on physical education teachers at all schools in the region. Between 2011 and 2019, 1,726 teachers from 208 schools [35% preschool-primary, 28% secondary, 28% private schools partly funded by public funds; 9% vocational] participated in the program. Sixty percent (619) were physical education teachers, who trained 59465 students. All schools have progressively been supplied with at least five BLS manikins each. In 2014, the regional government of Navarra approved mandatory BLS education in physical education in primary and secondary schools. With adequate education and proper support, physical education teachers can independently implement a Basic Life Support program in their schools aiming to increase bystander cardio-pulmonary resuscitation competencies. Furthermore, the Basic Life Support education increases students’ confidence of social responsibilities and awareness of cardiac arrest as a public health problem.

P21-15 Feasibility of a nurse-initiated CBI program for symptom clusters in advanced NSCLC patients - a qualitative study

Patients with advanced non-small cell treatment concurrently experienced a variety of symptoms, forming symptom clusters, affecting their quality of life(QOL). We developed a Symptom Cluster Reduction Life Support Program (Support program) to reduce the burden on advanced NSCLC patients based on a nurse-initiated Cognitive Behavioral Intervention (CBI), and evaluated the feasibility of the program.

Efficacy of Basic Life Support and Automatic External Defibrillator Educational Program for High School

Background: Bystander-initiated cardiopulmonary resuscitation (CPR), the automatic external defibrillator (AED), and rapid activation of emergency medical service have major roles in the chain of survival of out-of-hospital cardiac arrest patients. To integrate the basic life support (BLS) knowledge into the high school curriculum, teachers are the key person. Objective: To examine the effectiveness of the BLS training program for high school teachers. Methods: In this prospective study of 146 participants, before and immediately after 2 hours lecture and 3 hours hands-on activity of BLS training program consisting of instruction on CPR, AED, and first aid for foreign body aspiration, written tests were done to assess knowledge while participants’ attitudes were evaluated by a questionnaire survey. Results: A total of 146 participants, BLS knowledge increased in all parts (early activation, chest compression, and defibrillation increased by 27.3%, 51.3%, and 82.1% with adjusted OR 13.81, 19.08, and 849.47, respectively; P &lt; .001), as well as participant’s confidence increased from 47.6% to 95.8% (adjusted OR, 31.69; P &lt; .001). Conclusions: BLS training in high school teachers increased both knowledge of chains of survival and confidence.

The Sword of Damocles: Family Presence and Extracorporeal Life Support During The COVID-19 Pandemic and Beyond.

During Ontario’s busiest surge of COVID-19 (coronavirus disease) to date, our Pediatric ICU at the Hospital for Sick Children (normally an entirely pediatric referral centre) admitted adult patients under our care. Our extracorporeal life support (ECLS) program quickly adapted to this new reality—we admitted adults previously cannulated to ECLS and cannulated a number of adult patients, while maintaining our usual pediatric ECLS cases. The following reflections stem from the family presence restrictions in place due to COVID-19, in particular the clarity these constraints have lent to our role in supporting families as they navigate the unique tension between life and death that is ECLS. Dionysius II, an ancient ruler of Syracuse, responded to a courtier’s flattery by having him rule in his stead for one day. That courtier, Damocles, eagerly embraced the opulence and power of his role but, looking up from his throne, noticed that Dionysius had placed a sword directly above his head—its handle was suspended from the ceiling by a single hair, to teach Damocles the danger inherent in the life of a ruler. Terrified, Damocles abandoned his newfound privileges and returned the crown to Dionysius. More than two millennia have passed, and we find ourselves struggling against the despotic rule of COVID-19, its viral structure even boasting its own corona, crown. Amidst the armamentarium of modern medicine, ECLS has affirmed its role as a last resort—veno-venous (V-V) ECLS, judiciously applied, has become a bridge to recovery1 (and in rare cases, lung transplantation2) with 90 day survival in the Extracorporeal Life Support Organization COVID-19 registry dashboard approaching 50%.3 When you place a patient on V-V ECLS after several hours of trying to coax gas exchange out of lungs which have become like stones, the team breathes a sigh of relief and, like Damocles surveying the gilt palace, basks in the glow of a better blood gas while the ECLS console hums with newfound hope in recovery. But like Damocles we all look up, sooner or later, and remember the sword that plagues our hopes and safety. Device failure, an intracranial bleed, an intrathoracic bleed, a gastrointestinal bleed, an opportunistic infection… these are kept at bay by a very thin thread. None of this is new to anyone who cares for patients supported on ECLS, yet we all forget at times to look up and ponder that sword. And more importantly, we struggle to help families maintain that awareness, to understand that when we say their loved one is stable on ECLS the latter two words represent a radical caveat to the first. The COVID-19 pandemic has served as an urgent reminder of the importance of ensuring families understand the inherently tenuous nature of their loved one’s path to recovery with ECLS. For those who cannot visit in person due to public health and infection control measures, it becomes imperative to use whatever tools are possible (including video platforms and language translation when necessary) to highlight the absolute dependence—of their spouse or partner, their parent, or their child or sibling—upon a machine that, at great risk, pumps blood in and out of their body through an oxygenator membrane. The myriad risks must be clear and ever present. For those who can visit, during and beyond COVID-19, we must advocate for frequent visits, daily if possible, consistent with the accompaniment that we would wish for any patient whose life hangs in the balance. COVID-19 has brought a tragic loss of life throughout the world, with the concomitant tragedy and trauma of countless patients who have borne suffering and died unaccompanied. Where public health authorities and infection control policies give us an inch we must take a mile and bring families to the bedside of patients supported on ECLS. When each day might see the sword of Damocles descend, it behooves us to make that sword visible and, more importantly, to make patients and families visible to one another as best we can. The challenge of supporting families through a patient’s prolonged dependence upon a terrifyingly high-risk therapy is a relatively novel challenge that will become more common in the years ahead, given the ever-expanding role of ECLS and increasingly versatile heart and organ-assist devices. How can we ensure that all parties glance with some regularity at the thin thread of survival, while also providing reassurance and encouraging some adaptation to a new normal that will never be normal? COVID-19 has served to highlight the fragile nature of communication in healthcare, and while the pandemic’s reign may end before long, we are now better equipped than ever before to engage patients and families in the day-to-day journey that is ECLS. Acknowledgment We wish to acknowledge the dedication of our extracorporeal life support (ECLS) team during our unprecedented role in treating adult patients with COVID-19 in our Pediatric ICU.

Key Considerations in Establishing a Pediatric Rescue Extracorporeal Life Support Program: A Multi Methods Review.

Extracorporeal life support (ECLS) is generally limited to centers with cardiac surgery. However, pediatric centers without cardiac surgery can still provide potentially lifesaving ECLS through a Rescue Program, allowing a local team to cannulate and stabilize patients before they are transported to a center with cardiac surgery support for ongoing care. This multimethod study provides an exploration of pediatric ECLS team insights regarding program implementation and offers recommendations for other centers wishing to develop a similar program. We performed surveys and semi-structured interviews to gather perspectives from ECLS team members. Demographics and preliminary perspectives were obtained from surveys. Interviews were transcribed and coded using thematic analysis to identify key considerations, facilitators, and barriers related to rescue program implementation. Our multidisciplinary ECLS team perceived great value in the rescue program and identified elements critical to successful program development and implementation, including barriers that might exist for any center wishing to set up a similar program. Participants emphasized that the initial design and continued maintenance of any Rescue ECLS Program be a comprehensive, multidisciplinary initiative. Clear communication, a mechanism for debriefing and feedback, and a strategy allowing for flexible program evolution are essential.

Advanced Life Support for out-of-hospital Chest Pain: The Opals Study

ABSTRACT Context: As many as 14% of patients transported by ambulance with chest pain die prior to hospital discharge. To date, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect survival for these patients. Objective: The Ontario Prehospital Advanced Life Support (OPALS) Study assessed the effect of adding an advance life support service to an existing basic life support emergency medical service program, on the rate of mortality and morbidity for patients with out-of-hospital chest pain. Design: Controlled clinical trial comparing survival for 9 months before and 9 after instituting an advanced life support program. Setting: Thirteen urban and suburban Ontario communities (populations ranging from 30,000 to 750,000; total, 2.5 million). Patients: All adult patients with a primary complaint of chest pain and transported by paramedics to the emergency department. Intervention: Paramedics were trained in standard advanced life support, which includes endotracheal intubation, intravenous furosemide and morphine, oral ASA, and sublingual NTG. Emergency medical services within each community had to meet predefined criteria in order to qualify for the advanced life support phase. Main Outcome Measure: Survival to hospital discharge. Results: Overall, 12,168 patients were enrolled in either the basic life support phase (N = 5,788) or the advanced life support phase (N = 6,380). The rate of mortality significantly decreased from 4.3% in the basic life support phase to 3.2% in the advanced life support phase (absolute change 1.1, 95% CI 0.4-1.8, P = 0.0013). We also demonstrated a decrease in mortality for the subgroup of patients with a discharge diagnosis of myocardial infarction (13.1 percent vs 8.2 percent, P = 0.002). Conclusions: The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. Future research should clarify the most effective interventions and target specific populations. ClinicalTrials.gov Identifier: NCT00212953