Mouth-to-mouth Research Articles

Duration of Ventilations During Cardiopulmonary Resuscitation by Lay Rescuers and First Responders

Background— The 2010 guidelines for cardiopulmonary resuscitation allow 5 seconds to give 2 breaths to deliver sufficient chest compressions and to keep perfusion pressure high. This study aims to determine whether the recommended short interruption for ventilations by trained lay rescuers and first responders can be achieved and to evaluate its consequence for chest compressions and survival. Methods and Results— From a prospective data collection of out-of-hospital cardiac arrest, we used automatic external defibrillator recordings of cardiopulmonary resuscitation by rescuers who had received a standard European Resuscitation Council basic life support and automatic external defibrillator course. Ventilation periods and total compressions delivered per minute during each 2 minutes of cardiopulmonary resuscitation cycle were measured, and the chest compression fraction was calculated. Neurological intact survival to discharge was studied in relation to these factors and covariates. We included 199 automatic external defibrillator recordings. The median interruption time for 2 ventilations was 7 seconds (25th–75th percentile, 6–9 seconds). Of all rescuers, 21% took <5 seconds and 83% took <10 seconds for a ventilation period; 97%, 88%, and 63% of rescuers were able to deliver >60, >70, and >80 chest compressions per minute, respectively. The median chest compression fraction was 65% (25th–75th percentile, 59%–71%). Survival was 25% (49 of 199), not associated with long or short ventilation pauses when controlled for covariates. Conclusions— The great majority of rescuers can give 2 rescue breaths in <10 seconds and deliver at least 70 compressions in a minute. Longer pauses for ventilations are not associated with worse outcome. Guidelines may allow longer pauses for ventilations with no detriment to survival.

Evaluation of knowledge and skills training of cardiopulmonary resuscitation in families of high-risk patients with sudden cardiac death

Objective To find an optimal mode for cardiopulmonary resuscitation (CPR) skills training to family members of high-risk patients with sudden cardiac death (SCD).Methods Totals of 132 family members of high risk patients of SCD were recruited with convenient sampling method.After an upgraded training procedure was applied to them,their CPR knowledge was tested immediately.Results Among 132 family members,76.5％ of the trainees passed the test in terms of CPR knowledge with a mean knowledge score (11.46 ± 1.84),items with lower correct rates on airway opening (75.8％),activating of EMS (76.5％),chest compression frequency (79.6％),and mouth-to-mouth resuscitation (84.1％).And 87.8％ of the trainees passed CPR skill test with a mean skill score (22.9 ± 1.24),items had lower correct rates on airway opening(87.1％),breathing (88.6％) and blowing effect (81.8％).Conclusions The upgraded procedure can raise the pass ratio of CPR training,and the relevance training on the artificial respiration is the difficulty key. Key words: Sudden cardiac death ; Cardiopulmonary resuscitation ; Training; Effect

Cardiac Abnormalities Rare in Infants with ALTE

Hoki R, Bonkowsky JL, Minich LL, et al. Cardiac testing and outcomes in infants after an apparent life-threatening event. Arch Dis Child. 2012; 97( 12): 1034- 1038; doi: 10.1136/archdis-child-2012-301668[OpenUrl][1][Abstract/FREE Full Text][2] Investigators from the University of Utah conducted a retrospective longitudinal cohort study to determine the prevalence and predictors of undiagnosed cardiac disease in infants presenting with an apparent life-threatening event (ALTE). The authors conducted a chart review using keywords and ICD-9 codes to identify infants <12 months of age who presented to Primary Children’s Medical Center (PMC) for an ALTE between 1999 and 2003. The medical records of study children were reviewed for presence of cardiac testing, demographics, medical history including prior ALTE, prematurity, use of rescue breaths, family history, and abnormal cardiac examination or concerning chest x-ray, with follow-up until 2009 to determine the results of any subsequent cardiac testing. The primary … [1]: {openurl}?query=rft.jtitle%253DArch%2BDis%2BChild%26rft_id%253Dinfo%253Adoi%252F10.1136%252Farchdischild-2012-301668%26rft_id%253Dinfo%253Apmid%252F23012307%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=archdischild&resid=97/12/1034&atom=%2Faapgrand%2F29%2F3%2F26.atom

Efficacy of ventilation and ventilation adjuncts during in-water-resuscitation—A randomized cross-over trial

IntroductionDrowning is a common cause of death in young adults. The 2010 guidelines of the European Resuscitation Council call for in-water-resuscitation (IWR). There has been controversy about IWR amongst emergency and diving physicians for decades. The aim of the present study was assessing the efficacy of IWR. MethodsIn this randomized cross-over trial, nineteen lifeguards performed a rescue manoeuvre over a 100m distance in open water. All subjects performed the procedure four times in random order: with no ventilation (NV) and transportation only, mouth-to-mouth ventilation (MMV), bag-mask-ventilation (BMV) and laryngeal tube ventilation (LTV). Tidal volumes, ventilation rate and minute-volumes were recorded using a modified Laerdal Resusci Anne manikin. Furthermore, water aspiration and number of submersions of the test mannequin were assessed, as well as the physical effort of the lifeguard rescuers.One lifeguard subject did not complete MMV due to exhaustion and was excluded from analysis. ResultsNV was the fastest rescue manoeuvre (advantage ∼40s). MMV and LTV were evaluated as efficient and relatively easy to perform by the lifeguards. While MMV (mean 199ml) and BMV (mean 481ml) were associated with a large amount of aspirated water, aspiration was significantly lower in LTV (mean 118ml). The efficacy of ventilation was consistently good in LTV (Vt=447ml), continuously poor in BMV (Vt=197) and declined substantially during MMV (Vt=1019ml initially and Vt=786ml at the end). The physical effort of the lifeguards was remarkably higher when performing IWR: 3.7 in NV, 6.7 in MMV, 6.4 in BMV and 4.8 in LTV as measured on the 0–10 visual analogue scale. ConclusionIWR in open water is time consuming and physically demanding. The IWR training of lifeguards should put more emphasis on a reduction of aspiration. The use of ventilation adjuncts like the laryngeal tube might ease IWR, reduce aspiration of water and increase the efficacy of ventilation during IWR.

CPR: Compression-Only Wins the Long Race

While rescue breathing might be important in certain situations, emergency medical service (EMS) dispatchers have a difficult time quickly establishing

Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis

Objective To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts.Design...

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Effect of Rescue Breathing During Cardiopulmonary Resuscitation on Lung Function After Restoration of Spontaneous Circulation in a Porcine Model of Prolonged Cardiac Arrest*

The destruction of the pulmonary structure after cardiopulmonary resuscitation may lead to lung function breakdown. The aim of this study was to investigate lung function after cardiopulmonary resuscitation and the influence of rescue breathing on lung function. Prospective, randomized animal study. A university animal research laboratory. Twenty-eight male domestic pigs weighing 30 ± 2 kg. The animals were randomized into three groups: continuous compressions (n = 12), 30:2 compression/rescue ventilation cardiopulmonary resuscitation (n = 12), and sham cardiopulmonary resuscitation (n = 4). Ventricular fibrillation was induced in the continuous compressions and compression/rescue ventilation groups. Cardiac output, extravascular lung water, and airway resistance were measured at baseline and 1, 2, and 4 hrs after restoration of spontaneous circulation. Thoracopulmonary compliance, lower inflection point, and dead space were calculated. Lung ventilation/perfusion scans with Tc were performed 48 hrs before the experiment and 24 hrs after restoration of spontaneous circulation. Conventional histopathology evaluation was performed. Dead space, airway resistance, lower inflection point, and extravascular lung water significantly increased and compliance decreased after restoration of spontaneous circulation in the continuous compressions and compression/rescue ventilation groups. Lung injury was more severe in the continuous compressions group. Significant differences were found between the two groups in the three time points after restoration of spontaneous circulation (p < 0.05). Variables of the sham cardiopulmonary resuscitation group remained stable during the whole protocol. Poor ventilation/perfusion and mismatch were found after restoration of spontaneous circulation, but the injury was mitigated in the compression/rescue ventilation group. Histopathology injury in the compression/rescue ventilation group was also improved. Appropriate rescue breathing during cardiopulmonary resuscitation does not influence the prognosis of cardiac arrest or the hemodynamics after restoration of spontaneous circulation but can improve lung function and alleviate lung injury.

Chest-Compression-Only Bystander Cardiopulmonary Resuscitation in the 30:2 Compression-to-Ventilation Ratio Era

The compression-to-ventilation ratio for basic cardiopulmonary resuscitation (CPR) was changed from 15:2 to 30:2, but there are few human studies comparing chest-compression-only CPR with standard CPR. From the All-Japan Utstein Registry in the 30:2 CPR era, 173,565 adult cardiac arrests witnessed by bystanders were included. On arrival at the scene, emergency medical services responders assessed the status of dispatcher-assisted CPR instruction and bystander CPR technique (chest compression with or without rescue breathing). The primary endpoint was favorable neurological outcome 30 days after cardiac arrest. The prevalence of dispatcher-assisted CPR instruction increased year by year, contributing to an overall increase of chest-compression-only bystander CPR from 20.6% to 35.0%. Among 78,150 patients receiving bystander CPR, favorable neurological outcome did not differ between dispatcher-assisted and -unassisted CPR (adjusted odds ratio [OR], 1.00; 95% confidence interval [CI]: 0.94-1.08). Chest-compression-only CPR resulted in better favorable neurological outcome than standard CPR in the whole cohort (adjusted OR, 1.09; 95% CI: 1.00-1.18) and in the subgroup with cardiac etiology (adjusted OR, 1.12; 95% CI: 1.02-1.22). The addition of rescue breathing provided no neurological benefit in the non-cardiac etiology subgroup. In the 30:2 CPR era, dispatcher-assisted CPR instruction contributed to an increase of chest-compression-only bystander CPR, supporting the use of chest-compression-only CPR for bystander-witnessed out-of-hospital cardiac arrest in all adults.

Chest Compression–Only Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest With Public-Access Defibrillation

Background— It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression–only cardiopulmonary resuscitation (CPR) or conventional CPR with rescue breathing. Methods and Results— A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression–only CPR and conventional CPR with compressions and rescue breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression–only CPR and 870 (63.2%) received conventional CPR. The chest compression–only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03–1.70). Conclusions— Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay rescuers can witness a sudden collapse and use public-access AEDs.

Chest Compression Alone Cardiopulmonary Resuscitation Is Associated With Better Long-Term Survival Compared with Standard Cardiopulmonary Resuscitation

Little is known about the long-term survival effects of type-specific bystander cardiopulmonary resuscitation (CPR) in the community. We hypothesized that dispatcher instruction consisting of chest compression alone would be associated with better overall long-term prognosis in comparison with chest compression plus rescue breathing. The investigation was a retrospective cohort study that combined 2 randomized trials comparing the short-term survival effects of dispatcher CPR instruction consisting either of chest compression alone or chest compression plus rescue breathing. Long-term vital status was ascertained by using the respective National and State death records through July 31, 2011. We performed Kaplan-Meier method and Cox regression to evaluate survival according to the type of CPR instruction. Of the 2496 subjects included in the current investigation, 1243 (50%) were randomly assigned to chest compression alone and 1253 (50%) were randomly assigned to chest compression plus rescue breathing. Baseline characteristics were similar between the 2 CPR groups. During the 1153.2 person-years of follow-up, there were 2260 deaths and 236 long-term survivors. Randomization to chest compression alone in comparison with chest compression plus rescue breathing was associated with a lower risk of death after adjustment for potential confounders (adjusted hazard ratio, 0.91; 95% confidence interval, 0.83-0.99; P=0.02). The findings provide strong support for long-term mortality benefit of dispatcher CPR instruction strategy consisting of chest compression alone rather than chest compression plus rescue breathing among adult patients with cardiac arrest requiring dispatcher assistance.

Abstract 190: Cardiopulmonary Resuscitation with Rescue Breathing Is Superior to Hands-Only Cardiopulmonary Resuscitation for Children and Infants: Results of a Systematic Review

Introduction: Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes. Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “In children and infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?” Methods: We performed a MEDLINE search (“compression only”[Title/Abstract]) AND cardiopulmonary resuscitation[MeSH Terms] with limits children (ages 0 -18). We also performed a search in the Cochrane database for systematic reviews, the Central Register of Controlled Trials, and EMBASE using similar search terms. We also searched applicable bibliographies and used the ‘Cited By’ function in Google Scholar. The study included papers if they evaluated the difference between compression only CPR and CPR with rescue breathing in infants or children. Papers that reported results from studies that used procedures that were beyond the basic life support level were excluded. Each paper was evaluated using specific criteria to determine the level of evidence. Results: Sixty-nine records were identified and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we assessed for eligibility. Eleven of these did not meet inclusion/exclusion criteria, leaving four that we included in the qualitative synthesis. Of these, one good quality study with level of evidence (LOE) 2a and 3 other studies (LOE 4) all opposed the hypothesis. There is a relative paucity of published data on this subject. The majority of the papers published describe evidence from animal models. Conclusions : In conclusion, rescuers should provide chest compressions with rescue breathing to children and infants in cardiac arrest; rescuers unwilling or unable to provide compressions with rescue breathing may provide chest compressions alone for these patients.

Abstract 20: Bystander Cardiopulmonary Resuscitation with Chest Compressions Only According to Dispatcher Telephone Instruction Status

BACKGROUND The 2010 AHA guidelines for cardiopulmonary (CPR) recommended that untrained lay rescuers should continue chest compression-only CPR under dispatcher-telephone CPR instruction and trained lay rescuers should continue conventional CPR if he or she is able to perform rescue breaths. We assessed the effect of bystander CPR according to dispatcher-telephone CPR instruction status. METHODS From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, we extracted the adult patients with bystander-witnessed out-of hospital cardiac arrest due to cardiac etiology, and divided into groups according to the dispatcher-telephone CPR instruction status, inclusive of CPR techniques. The primary endpoint was 30-day favorable neurological outcome after cardiac arrest. RESULTS Of the 113,624 patients who met the inclusion criteria, 45,565 received dispatcher-telephone CPR instruction and 68,059 did not. Higher proportions in the instruction group than in the no instruction group were the performance of bystander CPR (chest-compression only CPR or conventional CPR) (68% [30,929/45,565] vs. 31% [20,900/68,059], p&lt;0.0001), especially that of chest-compression only CPR (46.2% [21,032/45,565] vs. 17.0% [11,541/68,059], p&lt;0.0001). Although frequencies of 30-day favorable neurological outcome in the instruction group were significantly lower than in the no instruction group for the whole cohorts (4.8% vs. 5.5%, p&lt;0.0001) and the subgroups of patients receiving bystander CPR (5.7% vs. 7.8%, p&lt;0.0001), chest-compression only CPR was equivalent or superior to conventional CPR in each group in terms of neurological benefit (5.7% vs. 5.9% in the instruction group, p=0.57, and 8.2% vs. 7.3% in the no instruction group, p=0.03). Among patents receiving bystander CPR, adjusted odds ratios of favorable neurological outcome were 1.2 (95% CI; 1.1 to 1.3) after no instruction group, and 1.1 (1.0 to 1.2) after chest-compression only CPR. CONCLUSIONS Bystander chest-compression only CPR was not inferior to conventional CPR in terms of neurological benefits, and dispatcher-telephone CPR instruction increased the performance rate of chest-compression only CPR.

Chest compression alone CPR is associated with better long-term survival compared to standard CPRStatus: PendingCategory: CPR Quality

Background —Little is known about the long-term survival effects of type-specific bystander CPR in the community. We hypothesized that dispatcher instruction consisting of chest compression alone would be associated with better overall long-term prognosis compared to chest compression plus rescue breathing. Methods and Results —The investigation was a retrospective cohort study that combined 2 randomized trials comparing the short-term survival effects of dispatcher CPR instruction consisting either of chest compression alone or chest compression plus rescue breathing. Long-term vital status was ascertained using the respective National and State death records through 31st July 2011. We performed Kaplan Meier method and Cox regression to evaluate survival according to the type of CPR instruction. Of the 2496 subjects included in the current investigation, 1243 (50%) were randomized to chest compression alone and 1253 (50%) were randomized to chest compression plus rescue breathing. Baseline characteristics were similar between the two CPR groups. During the 1153.2 person-years of follow-up, there were 2260 deaths and 236 long-term survivors. Randomization to chest compression alone compared to chest compression plus rescue breathing was associated with a lower risk of death after adjustment for potential confounders (adjusted HR=0.91; 95% CI [0.83-0.99], p=0.02). Conclusions —The findings provide strong support for long-term mortality benefit of dispatcher CPR instruction strategy consisting of chest compression alone rather than chest compression plus rescue breathing among adult cardiac arrest patients requiring dispatcher assistance.

CONTINUOUS COMPRESSION WITHOUT DEFIBRILLATION FAVOURED NO SHORT-TERM SURVIVAL IN PROLONGED VENTRICULAR FIBRILLATION

CONTINUOUS COMPRESSION WITHOUT DEFIBRILLATION FAVOURED NO SHORT-TERM SURVIVAL IN PROLONGED VENTRICULAR FIBRILLATION

Brain Resuscitation in the Drowning Victim

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

Chest compression-only cardiopulmonary resuscitation performed by lay rescuers for adult out-of-hospital cardiac arrest due to non-cardiac aetiologies

ObjectiveBystander CPR improves survival in patients with out-of-hospital cardiac arrest (OHCA). For adult sudden collapse, bystander chest compression-only CPR (COCPR) is recommended in some circumstances by the American Heart Association and European Resuscitation Council. However, adults who arrest from non-cardiac causes may also receive COCPR. Because rescue breathing may be more important for individuals suffering OHCA secondary to non-cardiac causes, COCPR is not recommended for these cases. We evaluated the relationship of lay rescuer COCPR and survival after OHCA from non-cardiac causes. MethodsAnalysis of a statewide Utstein-style registry of adult OHCA, during a large scale campaign endorsing COCPR for OHCA from presumed cardiac cause. The relationship between lay rescuer CPR (both conventional CPR and COCPR) and survival to hospital discharge was evaluated. ResultsPresumed non-cardiac aetiologies of OHCA accounted for 15% of all cases, and lay rescuer CPR was provided in 29% of these cases. Survival to hospital discharge occurred in 3.8% after conventional CPR, 2.7% after COCPR, and 4.0% after no CPR (p=0.85). The proportion of patients receiving COCPR was much lower in the cohort of OHCA from respiratory causes (8.3%) than for those with presumed cardiac OHCA (18.0%; p<0.001). ConclusionsIn the setting of a campaign endorsing lay rescuer COCPR for cardiac OHCA, bystanders were less likely to perform COCPR on OHCA victims who might benefit from rescue breathing.

Load-distributing band improves ventilation and hemodynamics during resuscitation in a porcine model of prolonged cardiac arrest

BackgroundThe use of mechanical cardiopulmonary resuscitation (CPR) has great potential for the clinical setting. The purpose of present study is to compare the hemodynamics and ventilation during and after the load-distributing band CPR, versus the manual CPR in a porcine model of prolonged cardiac arrest, and to investigate the influence of rescue breathing in different CPR protocols.MethodsSixty-four male pigs (n = 16/group), weighing 30 ± 2 kg, were induced ventricular fibrillation and randomized into four resuscitation groups: continuous load-distributing band CPR without rescue ventilation (C-CPR), load-distributing band 30:2 CPR (A-CPR), load-distributing band CPR with continuous rescue breathing (10/min) (V-CPR) or manual 30:2 CPR (M-CPR). Respiratory variables and hemodynamics were recorded continuously; blood gas was analyzed.ResultsTidal volume produced by compressions in the A-, C- and V-CPR groups were significantly higher compared with the M-CPR group (all p < 0.05). Coronary perfusion pressure of the V-CPR group was significantly lower than the C-CPR group (p < 0.01), but higher than the M-CPR group. The increasing of lung dead space after restoration of spontaneous circulation was significantly greater in the M-CPR group compared with the A-, C- and V-CPR groups (p < 0.01). Blood pH gradually decreased and was lower in the M-CPR group than that in the A-, C- and V-CPR groups (p < 0.01). PaO2 of the A-, C- and V-CPR groups were significantly higher and PaCO2 were significantly lower compared with the M-CPR (both p < 0.05). Cerebral performance categories were better in the A-, C- and V-CPR groups compared with the M-CPR group (p < 0.0001).ConclusionsThe load-distributing band CPR significantly improved respiratory parameters during resuscitation by augmenting passive ventilation, and significantly improved coronary perfusion pressure. The volume of ventilation produced by the load-distributing band CPR was adequate to maintain sufficient gas exchange independent of rescue breathing.

Comparison of Muscle Exertion and Fatigue Between Standard Bag Valve Mask and NuMask

Ventilation is an important part of cardiopulmonary resuscitation (CPR) performed by medical professionals. The self-inflating bag valve mask (BVM) is often used to deliver rescue breaths during CPR. As resuscitation may last for extended periods of time, it is important that the equipment used reduces the potential of operator fatigue, which could lead to decreased performance and substandard patient care. The NuMask is an intraoral mask designed as an alternative to the pre-inflated mask typically used with a BVM. This pilot study uses muscle exertion electromyography, Borg’s CR10 pain scale, and a Likert-scale questionnaire to compare muscle contraction, fatigue, and user preference between these two interfaces when ventilating a difficult airway mannequin. No significant differences were found in muscle pain or interface preference, but significantly lower muscular exertion by the non-dominant thenar eminence when using the NuMask suggests this interface could reduce user fatigue during extended periods of ventilation. A larger, more conclusive study is necessary to confirm these results.

Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses

In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPPs), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n = 30) trained by two OPPs in Los Angeles were interviewed in 2010-2011 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPPs. Injecting the victim with naloxone was the most commonly recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPPs, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques.