Management Of Cardiopulmonary Arrest Research Articles

Dissemination of Cardiopulmonary Resuscitation Training for Nurses Treating Coronavirus Disease-2019 Patients: A Single-arm Pre-experimental Study.

IntroductionProviding cardiopulmonary resuscitation (CPR) to a coronavirus disease-2019 (COVID-19) patient is challenging for the healthcare providers (HCP). COVID-19 cases have specific CPR requirements, which differ from standard resuscitation efforts.ObjectiveThis paper aims to evaluate whether online learning can be an effective methodology for imparting information on the management of cardiopulmonary arrest in COVID-19 patients due to a novel virus unknown to HCP based on evaluation of knowledge acquisition and satisfaction of the nurses in the new area of medicine and virology.MethodologyIn a single-arm, one group before and after design, from a cohort of 160 nurses trained in comprehensive cardiac life support (CCLS) formulated by the Indian Resuscitation Council (IRC), 73 nurses participated in the study. After obtaining informed consent through the email from the nurses, baseline data including demographic profile and knowledge related to CPR in COVID-19 patients were collected. An online intervention spread over 1 week was given using a validated e-learning module. The online intervention was found to be effective (pre- and post-intervention knowledge score 13.65 ± 3.01 vs 19.92 ± 1.94, p = 0.001). The majority of nurses were highly satisfied with the content and the training methodology (37.23 ± 4.70).ConclusionA well-structured, online study material can be used in imparting knowledge and demonstrating the basic and essential skills to nurses, required for giving CPR to COVID-19 patients.How to cite this articleJoshi P, Das S, Thomas M, Mawar S, Garg R, Shariff A, et al. Dissemination of Cardiopulmonary Resuscitation Training for Nurses Treating Coronavirus Disease-2019 Patients: A Single-arm Pre-experimental Study. Indian J Crit Care Med 2022;26(3):327–330.

Management of cardiopulmonary arrest in an educational video: contributions to education in pediatric nursing.

Objective:to make and validate an educational video about the management of pediatric cardiopulmonary arrest caused by respiratory failure.Method:methodological study developed in three stages: preparation and validation of a clinical case; production; and validation of educational video. To build the educational video, the Fleming, Reynolds and Wallace methodological framework was used.Results:the clinical case was validated by ten expert referees, who worked as nurses in different regions in Brazil, by completing an online form, with one round of evaluation and calculation of the content validity index. The educational video was validated by three expert judges and 25 nursing students in an evaluation round and contains six scenes, with duration of nine minutes and 56 seconds. An agreement over 80% was reached for most of the items in both the clinical case and the educational video.Conclusion:the educational video proved valid regarding face and content. This educational technology has the potential to meet the demands of students, who are digital natives, related to teaching of management of pediatric cardiopulmonary arrest caused by respiratory failure.

A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests.

Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS. What is Known • Levels of preparedness to be a paediatric cardiopulmonary arrests team member/leader are generally lower than desirable. • The importance of nontechnical skills to the effective performance of adult cardiopulmonary arrests teams has been identified. What is New • Levels of preparedness to be a cardiopulmonary arrests team member were higher than reported in US studies. • There is a need for greater training in cardiopulmonary arrest management which includes a focus on key nontechnical skills to include identifying options, prioritising, identifyingand utilising resources.

Resucitación cardiopulmonar y cerebral en la embarazada. Al final del colapso materno

<p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;"><strong>Objetivo:</strong><span class="Apple-converted-space"> </span>proporcionar a los profesionales de la salud involucrados en el manejo de gestantes con complicaciones (obstetras, enfermeras, médicos generales y de emergencias, anestesiólogos, intensivistas, entre otros) los principios fundamentales de prevención y manejo de paro cardiorrespiratorio (PCR) en este grupo poblacional con el fin de mejorar los resultados del binomio madre-hijo.</p><p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;"><strong>Materiales y métodos:</strong><span class="Apple-converted-space"> </span>el documento se basa en una búsqueda de publicaciones en las bases de datos Medline, SciELO y Embase utilizando los términos "Cardiopulmonary Resuscitation, Pregnancy, Perimortem Cesarean, Maternal Cardiac Arrest, Cardiac arrest in pregnancy", y restringida a los siguientes tipos de publicación: "Meta Analysis, Systematic Reviews, Practice Guideline, Randomized Controlled Trial, Review, Case Report, Chapter, Editorial, Survey".</p><p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;"><strong>Resultados</strong>: se encontraron 78 títulos de los cuales se incluyeron 63; de estos, 22 corresponden a revisiones narrativas, 20 a reportes y series de caso, 8 a guías de práctica clínica, 5 a ensayos clínicos, 4 editoriales, 2 corresponden a revisiones sistemáticas o metaanálisis, 1 capítulo de libro y 1 encuesta o<span class="Apple-converted-space"> </span><em>survey</em>.</p><p style="font: small/normal verdana; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; widows: 1; font-size-adjust: none; font-stretch: normal; -webkit-text-stroke-width: 0px;"><strong>Conclusiones</strong>: el paro cardiaco en gestantes impone un reto al grupo interdisciplinario que lo enfrenta, por ser una entidad de baja frecuencia que se puede asociar a un alto grado de morbimortalidad materna y perinatal. Las principales acciones por realizar son: activación del código azul obstétrico con respuesta adecuada para realización de histerotomía de emergencia oportuna, compresiones torácicas de buena calidad, desviación manual uterina 15º a la izquierda cuando el útero grávido se palpe por encima del ombligo materno, manejo avanzado farmacológico y de vía aérea, y cuidado óptimo luego de la resucitación para la madre y el neonato.</p>

Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders.

Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6months after the initial assessment. At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.

Epinephrine for prehospital cardiac arrest with non-shockable rhythm

Cardiopulmonary arrest research and guidelines have generally focused on the treatment and management of ventricular fibrillation and pulseless ventricular fibrillation (electrical shockable rhythms). Less investigation has been done on the subpopulation of cardiopulmonary arrest victims that present with non-shockable rhythms. In a new paper, Goto, Maeda, and Goto present evidence that early use of epinephrine for treatment is associated with better survival with functional outcome. While there is a lack of evidence to support epinephrine for management of cardiopulmonary arrest presenting with initial shockable rhythms (presumed primary cardiac origin), there is now evidence that epinephrine may potentially benefit those presenting with non-shockable cardiopulmonary arrest (presumed heterogeneous origins). Further research on non-shockable rhythm cardiopulmonary arrest is needed to understand the subpopulation and develop better treatment guidelines.

Quality of resuscitation orders in general medical patients

Documentation of resuscitation status in hospitalized patients has relevance in the management of cardiopulmonary arrest. Its association with mortality, Length Of hospital Stay (LOS) and the patients' primary diagnosis has not been established in general medical inpatients in hospitals in Australia and New Zealand. To investigate the association of resuscitation orders with in-hospital mortality and LOS in a range of diagnoses, adjusting for severity of illness and other covariates. Retrospective study. The admission notes of 1681 medical admissions to four tertiary care teaching hospitals across Australia and New Zealand were reviewed retrospectively for frequency and nature of resuscitation documentation and its association with mortality, LOS and primary diagnosis. Resuscitation orders were documented in 741 patients (44.7%). For the 232 patients with a Not For Resuscitation (NFR) order, the in-hospital mortality rate was higher than in control patients (14% vs. 1.2%, P<0.005). The mortality rate remained significantly higher in the NFR group after propensity matching of the controls for age and co-morbidity (14% vs. 5%, P<0.005). The death-adjusted LOS for the NFR group was also significantly higher compared to the control patients (9.7 days vs. 4.7 days, P<0.005) and this difference remained after propensity matching (9.7 days vs. 7.7 days, P<0.05). Those patients with a primary diagnosis of respiratory tract infection or cardiac failure were more likely to be documented NFR compared to those with cellulitis or urinary tract infection. The documentation of NFR in a patient's admission notes is associated with increased in-hospital mortality and LOS. This is only partly explicable in terms of these patients' greater age and co-morbidity.

Cognitive Aids Do Not Prompt Initiation of Cardiopulmonary Resuscitation in Simulated Pediatric Cardiopulmonary Arrest.

BACKGROUND: While American Heart Association (AHA) guidelines exist for proper management of cardiopulmonary arrest (CPA), in-hospital cardiopulmonary resuscitation (CPR) is often of poor quality and is not performed in all indicated situations. Pediatric CPA is additionally challenging due to complexity associated with weight-based medication dosing and low volume of health care provider experience. Code cards have been created to assist in rapid, accurate recall of the guidelines for pediatric CPA management and serve as an example of a cognitive aid, a device to supplement clinical decision-making. Such aids are now routinely used in other industries in high stress situations which are more prone to error. However, no published study to date has evaluated whether cognitive aid use prompts CPR initiation during pediatric CPA. OBJECTIVES: Primary outcome: 1) Calculate proportion of pediatric residents a) who are not performing CPR on the simulated ’pulseless’ patient when cognitive aid use is initiated and b) who then initiate CPR after cognitive aid use. Secondary outcomes: 1) Calculate a) proportion of residents who use a cognitive aid during simulated CPA and b) mean time to initial cognitive aid use. 2) Document action immediately following cognitive aid use. METHODS: Observational, descriptive study. Residents participated in individual mock codes over 2 years during competency assessments. Utilizing a high fidelity simulator, each resident participated in a standardized scenario that involved pulseless ventricular tachycardia and pulseless electrical activity. Residents were permitted to utilize items normally available in code situations, such as stethoscopes and cognitive aids. Cognitive aid use was documented if a resident referred to it to make a medical decision. Data was objectively assessed using videotapes and time-stamped computer logs. RESULTS: 132/158 (83.5%) of pediatric residents participated. 125/132 (95%) of videotapes were available for review. 107/125 (85.6%) of residents used a cognitive aid. Mean time to cognitive aid use was 106 seconds (+/-100) after the patient became pulseless. Most common immediate actions prompted by cognitive aid use were: defibrillation 43/107 (40%) and epinephrine administration 27/107 (25%). Of those residents who used the AHA Pediatric Advanced Life Support (PALS) aid, 11/41 (27%) inappropriately chose ’tachycardia with poor perfusion’ algorithm instead of ’pulseless’ algorithm. Using this algorithm resulted in cardioversion and adenosine administration, delaying appropriate actions of defibrillation and epinephrine administration. Most alarming, 58/107 (54%) were not performing CPR on the pulseless patient when cognitive aid use was initiated. Furthermore, despite actively using a cognitive aid, only 2/58 (3.4%) were prompted to initiate chest compressions. CONCLUSION: Initiation of timely CPR is a vital link in the chain of survival. This study demonstrates that current cognitive aids do not prompt initiation of these critical basic life support skills, likely contributing to delays and errors in cardiopulmonary arrest management. Pediatric residents appear to use cognitive aids early and often in cardiopulmonary arrests in an effort to effectively manage highly stressful events with high morbidity and mortality. Failure to prompt CPR initiation by these aids represents a ’missed opportunity’ to enhance performance of these vital skills. Future studies will objectively evaluate impact of cognitive aid design on CPR performance.

Management of Cardiopulmonary Arrest in the Rehabilitation Setting

Life-threatening cardiac and respiratory arrests are stressful emergency situations. Nurses may be anxious and unsure of what needs to be done if their roles are not clearly defined. This article describes a system one rehabilitation hospital uses when responding to arrests, reviews the steps in basic cardiopulmonary resuscitation, and presents an algorithm of a cardiopulmonary arrest.

The Esophageal Obturator Airway

The Esophageal Obturator Airway, a device designed for use in the management of cardiopulmonary arrest, obstructs the esophagus while simultaneously ventilating the lungs. The EOA was clinically tested in 29,000 patients with a low incidence of false entries and complications. Physiological studies indicated that vital capacity, blood gases, and pH were comparable to those obtained with the use of the endotracheal tube. Furthermore, the insertion of the EOA was more rapid (mean 6 sec vs 20 sec), more accurate (98 percent vs 48 percent), and easier to teach to paramedical personnel. It was concluded that whenever optimal conditions for endotracheal intubation are unavailable, the EOA should be first choice in the management of the airway in aneflexic, apneic patients. Specific contraindications are listed.