Prior Cardiopulmonary Resuscitation Research Articles

Factors Influencing Perceived CPR Hands-Only Skill Retention Among High School Students

Retention refers to an individual's ability to retain or recall information, knowledge, or skills acquired through learning. Proficiency in performing Cardiopulmonary Resuscitation (CPR) is essential for high school students to enhance their preparedness for emergencies. One of the most straightforward CPR techniques for laypersons is CPR Hands-Only. This study aims to identify the factors influencing the post-training self-assessed perceived retention of CPR skills among high school students. A cross-sectional approach was employed, involving 111 high school students participating in a CPR Hands-Only training program. Participants were selected using a purposive sampling technique. Data were collected using structured self-assessment questionnaires to evaluate age, gender, class level, history of witnessing heart attacks, prior CPR training, knowledge, confidence, and perceived skill retention. Multivariate logistic regression was used for data analysis. Class level, knowledge, and confidence are found to influence CPR skill retention (p<0.05) significantly. 76.6% of participants have reported perceiving themselves as capable of retaining CPR skills, with most demonstrating moderate to high levels of knowledge and confidence. Age and gender do not have a significant impact, and prior exposure to heart attacks or CPR training also shows no notable effect on skill retention. The findings indicate that educational level, knowledge enhancement, and confidence-building are critical factors for successful CPR skill retention. Adapting training methods to these factors can improve training effectiveness and emergency preparedness, particularly in regions like Indonesia, where CPR training is not yet routinely integrated into school programs.

Utilization rates and heart transplantation outcomes of donation after circulatory death donors with prior cardiopulmonary resuscitation

BackgroundHeart donation after circulatory death (DCD) involves mandatory exposure to warm ischemic injury (WII) due to donor cardiac arrest resulting from withdrawal of life-support (WLS). However, potential DCD donors may also experience a cardiac arrest and undergo cardiopulmonary resuscitation (CPR) and associated WII before WLS. We sought to investigate the effect of previous donor-CPR in DCD heart-transplantation (HT). MethodsBetween January-2020 and April-2023, we identified 11,415 adult HTs in UNOS of whom 9456 met study criteria and had information on donor-CPR. Follow-up was available till April-2024. Study cohort was divided into four groups based on DCD vs. donation after brain death (DBD) status and donor-CPR i.e., DCD/CPR+ (n = 387), DCD/noCPR (n = 305), DBD/CPR+ (n = 5158) and DBD/noCPR (n = 3606); and compared for HT characteristics and outcomes. ResultsWith DBD/noCPR HTs as reference cohort, there were no significant differences in mortality in other HT cohorts (DCD/CPR+, DCD/noCPR and DBD/CPR+) upto 1-year of follow up using Kaplan-Meier analysis; and both unadjusted and adjusted Cox hazards-ratio models. Results were similar in propensity-matched cohorts. Duration of donor-CPR (≤20 min vs >20 min) did not influence HT survival; and rates of in-hospital secondary outcomes were similar. The utilization rates of both adult DCD/CPR+ (3.39 % to 9.71 %) and DCD/noCPR donors (4.41 % to 10.34 %) increased significantly (p < 0.01) during study period. ConclusionsThe utilization rates of both DCD/CPR+ and DCD/noCPR donors have increased at an equal pace. A significant proportion of DCD HTs were from donors with prior CPR, but this was not associated with worse short-term survival.

Abstract Su401: Confidence in performing CPR after training with traditional and female-breasted manikins

Introduction: Studies have documented that females experiencing an OHCA are significantly less likely to receive cardiopulmonary resuscitation (CPR) than males in public locations. Reasons for this disparity include bystanders fear of being perceived as sexualizing or assaulting females during CPR, concerns about physically injuring females, or low confidence in rendering CPR on females. This pilot study aimed to assess the confidence of CPR trainees who were trained on both traditional and female-breasted manikins. Methods: Participants were enrolled at a community bystander CPR training for teachers at an urban public school in 2024. Participants who consented to participate in the study were asked to complete surveys. All participants received a didactic on hands-only CPR, followed by two sets of hands-on practice, first with a traditional manikin, and then with a female-breasted manikin or vice versa. Results: Of the 112 participants enrolled in the study, 88.4% were women, and 14% were &gt;50 years of age. The sample was almost all White participants, with high education status (88.4% with a Master’s or college education). The majority (86.6%) had prior CPR training, but most of them reported receiving training more than a year ago. After the two sets of practice (one with traditional manikin, and one with female manikin), 84.7% felt confident to perform CPR on both males and females, while 9.9% felt more confident to perform CPR on female and 5.4% on male. Men and women (84.6% and 84.7%, respectively) felt equally confident in performing CPR on both males and females. Although 28.4% felt either ‘slightly uncomfortable’ or ‘very uncomfortable’ with use of the female manikin, after practicing on a female manikin, 81.6% felt more comfortable with doing CPR on women (11.1% still felt uncomfortable and 7.3% were neutral). When asked which manikin made them feel more confident in performing CPR, 70.9% reported both, while 7.2% said neither, 10% said female manikin and 11.8% selected traditional manikin. 70% of women and 75% of men selected both manikins. Conclusion: Training with both types of anatomically accurate manikins is important in improving confidence of community lay responders in performing CPR and reducing community level gender disparities. Future analysis will evaluate change in confidence with each manikin type and assess confidence and knowledge retention 6 months after the training.

KNOWLEDGE OF CARDIO-PULMONARY RESUSCITATION AMONG FIRST-YEAR NURSING STUDENTS

: In the dynamic realm of healthcare, proficiency in cardiopulmonary resuscitation (CPR) stands as a cornerstone skill for nursing professionals. First-year nursing students represent the future frontline caregivers entrusted with the critical responsibility of preserving human life during emergencies. Methods: A descriptive cross-sectional study was conducted from January to April 2024 at the Superior University Department of Nursing in Lahore, to assess CPR knowledge among first-year nursing students. The study, involving 80 participants selected through convenient sampling, included students without prior CPR training. Data was collected using a demographic questionnaire and a CPR Knowledge Questionnaire, with scores ranging from 0 to 77. Analysis was performed using SPSS 25.Results: The results of the study provide a comprehensive overview of the participants' demographics and their knowledge about CPR. Most participants were under 30 years old (91.3%), with nearly equal numbers living in hostels (48.8%) and as day scholars (51.2%). A significant majority were single (95%). Knowledge about CPR varied, with 53.8% of participants having average knowledge and 46.3% having good knowledge. Responses revealed varying levels of understanding about CPR's purpose, procedures, and effectiveness, highlighting a need for improved education and training. Conclusion: The study shows that most nursing students are under 30 years old, with a near-equal distribution between hostel residents and day scholars, and a majority are single. Overall, 53.8% have average CPR knowledge, while 46.3% have good knowledge.

Incorporation of Drone Technology Into the Chain of Survival for OHCA: Estimation of Time Needed for Bystander Treatment of OHCA and CPR Performance.

Drone-delivered automated external defibrillators (AEDs) hold promises in the treatment of out-of-hospital cardiac arrest. Our objective was to estimate the time needed to perform resuscitation with a drone-delivered AED and to measure cardiopulmonary resuscitation (CPR) quality. Mock out-of-hospital cardiac arrest simulations that included a 9-1-1 call, CPR, and drone-delivered AED were conducted. Each simulation was timed and video-recorded. CPR performance metrics were recorded by a Laerdal Resusci Anne Quality Feedback System. Multivariable regression modeling examined factors associated with time from 9-1-1 call to AED shock and CPR quality metrics (compression rate, depth, recoil, and chest compression fraction). Comparisons were made among those with recent CPR training (≤2 years) versus no recent (>2 years) or prior CPR training. We recruited 51 research participants between September 2019 and March 2020. The median age was 34 (Q1-Q3, 23-54) years, 56.9% were female, and 41.2% had recent CPR training. The median time from 9-1-1 call to initiation of CPR was 1:19 (Q1-Q3, 1:06-1:26) minutes. A median time of 1:59 (Q1-Q3, 01:50-02:20) minutes was needed to retrieve a drone-delivered AED and deliver a shock. The median CPR compression rate was 115 (Q1-Q3, 109-124) beats per minute, the correct compression depth percentage was 92% (Q1-Q3, 25-98), and the chest compression fraction was 46.7% (Q1-Q3, 39.9%-50.6%). Recent CPR training was not associated with CPR quality or time from 9-1-1 call to AED shock. Younger age (per 10-year increase; β, 9.97 [95% CI, 4.63-15.31] s; P<0.001) and prior experience with AED (β, -30.0 [95% CI, -50.1 to -10.0] s; P=0.004) were associated with more rapid time from 9-1-1 call to AED shock. Prior AED use (β, 6.71 [95% CI, 1.62-11.79]; P=0.011) was associated with improved chest compression fraction percentage. Research participants were able to rapidly retrieve an AED from a drone while largely maintaining CPR quality according to American Heart Association guidelines. Chest compression fraction was lower than expected.

Knowledge, attitudes, practices, and self-efficacy of the Chinese public regarding cardiopulmonary resuscitation: an online cross-sectional survey.

To evaluate the current status of Chinese public's knowledge, attitudes, practices (KAP) and self-efficacy regarding cardiopulmonary resuscitation (CPR), and to analyze the factors that influence KAP and self-efficacy. An online cross-sectional survey was conducted from February to June 2022 in Mainland China via a self-designed self-filled questionnaire. Potential participants were recruited through WeChat by convenience sampling and snowball sampling methods. Descriptive and quantitative analyses were used for statistical analysis. The survey included 4,450 participants from 31 provinces, autonomous regions, or municipalities across Mainland China, aged 18 or above. The public's average understanding (clear and very clear) of the knowledge regarding CPR was 67.4% (3,000/4,450), with an average proportion of positive attitudes at 96.8% (4,308/4,450). In practice, the average proportion of good practices was 92.8% (4,130/4,450), while the percentage of good self-efficacy averaged at 58.9% (2,621/4,450), only 42.4% (1,885/4,450) of the participants had confidence in the correct use of automated external defibrillator (AED). Pearson correlation analysis showed a significantly positive correlation among knowledge, attitude, practice, and self-efficacy (p < 0.01). Multiple linear regression analysis revealed that several factors have a significant influence on the public's CPR KAP and self-efficacy, including ever having received CPR training (p < 0.001), hearing about AED (p < 0.001), performing CPR on others (p < 0.001), hearing about CPR (p < 0.001), occupation (p < 0.001), personal health status (p < 0.001), education level (p < 0.001), gender (p < 0.001), and encountering someone in need of CPR (p = 0.021). The Chinese public demonstrates good knowledge of CPR, positive attitude, and high willingness to perform CPR. However, there is still room for improvement in the mastery of some professional knowledge points related to CPR and AED. It should be noted that knowledge, attitude, practice, and self-efficacy are interrelated and influence each other. Factors such as prior CPR training, hearing about AED, having performed CPR before, hearing about CPR, occupation, personal health status, education level, gender, and having encountered someone in need of CPR have a significant impact on the public's KAP and self-efficacy.

Improve Survival of Out of Hospital Cardiac Arrest with Video-directed Chest Compressions

Background: Cardiovascular disease has been the leading cause of mortality worldwide for the past century, but advancements in health intervention have led to a decline of over 20%. However, the Out of Hospital Cardiac Arrest (OHCA) mortality rate remains unacceptably high, exceeding 90% over the past few decades. The primary reasons are the lack of cardiopulmonary resuscitation (CPR) knowledge and delayed medical response [1]. In 2018, the American Heart Association (AHA) introduced audio-directed CPR by 911 operators. However, the effectiveness of this approach in guiding laypeople to perform CPR is far from optimal [2]. Methods: Laypeople were randomly divided into audio and video groups, with each group receiving instructions through their respective medium on how to perform CPR on manikins. Simulated OHCA scenarios were created, involving on-site testing with subjects having no prior CPR experience, and a remote call site providing CPR instructions either through audio or video. Both on-site and online activities were recorded and analyzed. The accuracy of hand positions, the time of CPR initiation, the speed and effectiveness (depth) of chest compressions were tracked and compared between the audio and video guided groups based on AHA requirements. Results: Across 61 trials, CPR initiation occurred in 22 ± 11 seconds in the audio group and 22 ± 6 seconds in the video group. Hand location accuracy was 77% in audio participants and 97% in video participants (p&lt;0.05). The average speed of CPR was 0.55 ± 0.23 seconds with audio guidance and 0.45 ± 0.27 seconds with video guidance. The effectiveness of compressions was 33% ± 39% in the audio group and significantly improved to 79% ± 26% in the video group (p&lt;0.0001). Conclusion: The implementation of a new video-guided CPR system can significantly enhance CPR effectiveness when compared to the audio-assisted approach.

Impact of a VA-ECMO in Combination with an Extracorporeal Cytokine Hemadsorption System in Critically Ill Patients with Cardiogenic Shock-Design and Rationale of the ECMOsorb Trial.

Cardiogenic shock and arrest present as critical, life-threatening emergencies characterized by severely compromised tissue perfusion and inadequate oxygen supply. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) serves as a mechanical support system for patients suffering shock refractory to conventional resuscitation. Despite the utilization of VA-ECMO, clinical deterioration due to systemic inflammatory response syndrome (SIRS) resulting from the underlying shock and exposure of blood cells to the artificial surfaces of the ECMO circuit may occur. To address this issue, cytokine adsorbers offer a valuable solution by eliminating blood proteins, thereby controlling SIRS and potentially improving hemodynamics. Consequently, a prospective, randomized, blinded clinical trial will be carried out with ECMOsorb. ECMOsorb is a single-center, controlled, randomized, triple-blinded trial that will compare the hemodynamic effects of treatment with a VA-ECMO in combination with a cytokine adsorber (CytoSorb®, intervention) to treatment with VA-ECMO only (control) in patients with cardiogenic shock (with or without prior cardiopulmonary resuscitation (CPR)) requiring extracorporeal, hemodynamic support. Fifty-four patients will be randomized in a 1:1 fashion to the intervention or control group over a 36-month period. The primary endpoint of ECMOsorb is the improvement of the Inotropic Score (IS) 72 h after the intervention. Prognostic indicators, including mortality rates, hemodynamic parameters, laboratory findings, echocardiographic assessments, quality of life measurements, and clinical parameters, will serve as secondary outcome measures. The safety evaluation encompasses endpoints such as air embolisms, allergic reactions, peripheral ischemic complications, vascular complications, bleeding incidents, and stroke occurrences. The ECMOsorb trial seeks to assess the efficacy of a cytokine adsorber (CytoSorb®; CytoSorbents Europe GmbH, Berlin, Germany) in reducing SIRS and improving hemodynamics in patients with cardiogenic shock who are receiving VA-ECMO. We hypothesize that a reduction in cytokine levels can lead to faster weaning from inotropic and mechanical circulatory support, and ultimately to improved recovery.

Publicly available online course as a promising tool for teaching and promoting first aid skills in cardiac arrest

Relevance. The probability of resuscitation in cardiac arrest depends on incident eyewitnesses’ ability to timely and correctly provide first aid to the victim. However, such skills require appropriate training. With poor availability of face-to-face training in cardiopulmonary resuscitation (CPR), alternative training formats, including online e-learning, are gaining prominence to ensure widest dissemination of the life-saving competencies among general population.The objective is to study personal experience and attitudes among the individuals who completed the publicly available open online course on basic CPR (basic life support) skills in order to identify prospects and practical value of such online distance training aimed at CPR skills mainstreaming and better training availability.Methods. From July 2020 to August 2022, we conducted an anonymous survey among individuals who had completed the public open online course on basic life support training presented in Russian language. Our digital questionnaire included 16 questions designed to collect information on prior CPR training experience, training constraints, willingness to engage in volunteer teaching of CPR principles and respondent demographics. Data was analyzed using nonparametric statistics.Results and discussion. The analytical sample included 4342 respondents, mostly residents of Russia (81.1 %), including women (63.1 %), individuals aged under 40 y. (81.2 %), those without prior medical education (84.9 %), as well as schoolchildren and students (41.5 %). 44.2 % of respondents received no prior CPR training before the online course, mainly because they had been unaware of its practical value (39.4 % of respondents without CPR training experience) or had not known where to get trained (34.4 %). 76.3 % of respondents confirmed willingness to engage in volunteer teaching of CPR principles. Willingness to teach CPR to other individuals was related to prior experience of resuscitation training (the rate of respondents ready for CPR teaching was 77.5 % among those with prior resuscitation training and 74.9 % among those without such prior training, p = 0.043).Conclusion. Poor public awareness of CPR training importance and limited availability of training are the major constraints in acquiring life-saving knowledge and skills. As a publicly available tool for remote self-training, including within blended distant-classroom learning, the free online training course opens up great prospects for extensive mainstreaming of first aid skills, offering broad public coverage. The majority of online training graduates are willing to engage in volunteer CPR teaching, thus providing additional opportunities to increase availability of CPR training.

Effectiveness of a Short Refresher Course on the Retention of Cardiopulmonary Resuscitation-Related Psychomotor Skills (REF-CPR).

Cardiopulmonary resuscitation (CPR) skills deteriorate within 6-12 months of formal basic life support (BLS) training. The impact of refresher BLS training timing and format on the retention of CPR-related psychomotor skills is still under investigation. This study aimed to assess the effectiveness of BLS refresher training on the retention of CPR psychomotor skills. This prospective randomized clinical trial was conducted between February 2018 to August 2020 at the Sultan Qaboos University Hospital, Muscat, Oman. Healthcare workers with prior CPR training were enrolled. Baseline CPR-related knowledge and skills were assessed; subsequently, all participants received CPR training until they achieved 100% performance. At six months, a preassessment test was conducted, after which the intervention group received refresher training while the control group did not. At 12 months, both groups underwent assessment. Little Anne® QCPR manikins (Laerdal Corp., Stavanger, Norway) were used to assess CPR performance at each stage. A total of 38 personnel participated in the trial, comprising 19 in each arm. Overall, there were equal numbers of males and females; 21 participants (55.3%) were nurses, 15 (39.5%) were physicians, and two (5.3%) were paramedics. All participants demonstrated good baseline CPR knowledge. Within the intervention and control groups, CPR performance was 72.7% and 75.8% (p = 0.638) at baseline, 87.2% and 88.5% (p = 0.682) at six months, and 93.8% and 79.4% (p = 0.010) at 12 months, perspectively. Refresher CPR training six months after initial training was found to promote skills retention at 12 months.

Immediate psychological impact on citizen responders dispatched through a mobile application to out-of-hospital cardiac arrests

BackgroundActivating citizen responders may increase survival after out-of-hospital cardiac arrest (OHCA) but could induce significant psychological impact on the citizen responders. We examined psychological impact among citizen responders within the first days following resuscitation attempt. Methods and ResultsA mobile phone application to activate citizen responders to perform cardiopulmonary resuscitation (CPR) was implemented in the Capital Region of Denmark. All dispatched citizen responders (September 2017 to May 2019) received a survey 90 minutes after an alarm, including self-rating of perceived psychological impact on a scale of 1–4.Of 5,395 included citizen responders, most (88.6%) completed the survey within 24 hours.The majority reported no psychological impact (68.6%), whereas 24.7%, 5.5% and 1.2% reported low, moderate, or severe impact, respectively. Severe impact was more commonly reported in the following groups: No CPR training (3.8% vs 1.2%, p = 0.02), age < 30 years (2.0% vs 0.9%, p < 0.001), female sex (1.8% vs 0.7%, p < 0.001), provided CPR (2.7% vs 1.0%, p < 0.001), and arrived prior to the emergency medical services (EMS) (2.8% vs 0.7%, p < 0.001) compared to no to moderate impact.Chi square test, Mann-Whitney U test, Fischer’s exact test and a logistic regression model were used to assess differences in psychological impact across groups. ConclusionVery few citizen responders reported severe psychological impact. Lack of prior CPR training, younger age, female sex, performing CPR and arrival prior to the EMS were associated with greater psychological impact. Though very few citizen responders reported severe impact, the possibility of professional debriefing should be considered in citizen responder programs.

Impact of cardiopulmonary resuscitation on organ donation in Switzerland.

The lack of suitable donor organs limits the number of solid organ transplants. Patients who underwent cardiopulmonary resuscitation (CPR) after cardiac arrest may represent a sizeable subgroup of deceased organ donors, as they often progress to brain death or have life-sustaining therapy withdrawn. We aimed to quantify deceased organ donation after CPR in Switzerland for the first time by analysing the characteristics of potential and utilised organ donors after CPR. Data on deceased adult and paediatric patients who were reported to and approved by Swisstransplant for organ donation were analysed, including both donation after brain death (DBD) and donation after controlled cardiocirculatory death (cDCD) from 2016 to 2018. We analysed baseline characteristics of potential donors who underwent CPR in the context of their hospitalisation, as compared with donors without prior CPR. Considering the varying characteristics between these two donor groups, we assessed the effect of CPR on different allocation outcomes (donor and organ utilisation, organ yield per utilised donor) using multivariable regression. Additionally, we present selected CPR circumstances and compared different subgroups of CPR donors according to duration of CPR and duration of no-flow time. Of the 461 deceased potential organ donors included in the analysis, 173 (37.5%) underwent CPR. CPR donors were, on average, younger (median age 53 vs 62, p &lt;0.001), had different causes of death (p &lt;0.001), and were more often of the cDCD type (30.1% vs 18.4%, p = 0.004) as compared with non-CPR donors. Of the 173 CPR donors, 152 (87.9%) could be utilised (minimum one organ transplanted), and in the multivariable analysis, utilisation rate was higher in the CPR donor group than in the non-CPR donor group (odds ratio 3.3, 95% confidence interval 1.1&ndash;11.5; p = 0.046). Organ specific utilisation of heart, liver, and kidney, and total organ yield per donor, did not differ significantly between CPR and non-CPR donors. Our study reveals that a substantial proprotion of deceased organ donors in Switzerland underwent CPR in context of their hospitalisation. CPR donors are different from non-CPR donors with respect to age, cause of death and donation type. However, when carefully selected according to their haemodynamic condition, CPR donors are comparable to non-CPR donors in terms of donor and organ utilisation, as well as the average organ yield. Thus, all patients who are resuscitated from cardiac arrest but who subsequently progress to death should be evaluated for organ donation. How CPR donors compare with non-CPR donors regarding transplant outcomes should be studied further.

Abstract 250: Effect of Coaching on Dispatch-assisted Cardiopulmonary Resuscitation: A Randomized Simulation Study

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for the good outcome of sudden cardiac arrest victims. Current guidelines recommend dispatch-assisted CPR (DACPR). Its quality, however, varies from case to case. The aim of this study was todetermine the effectiveness of dispatch coaching on the quality of CPR by lay rescuers. Methods: We conducted a DACPR simulation study. Participants with no prior CPR training within 1 year were assigned randomly to one of two DACPR simulations (No Coaching Group: callers were told to perform CPR and the dispatcher sometimes confirmed if the caller was performing CPR or Coaching Group: the dispatcher coached, encouraged, and counted out loud with a metronome). The study participants performed CPR for 2 minutes under the study dispatcher. All performances were recorded by video camera and Resusci Anne® QCPR (Laerdal, Norway). Results: Forty-nine participants aged 20s to 50s were recruited, and 48 completed the simulation (Coaching Group, 27, 9 males and No Coaching Group, 21, 16 males). The average rate of chest compressions was 102.5/min in Coaching Group and 109.3/min in No Coaching group (p=0.270). The average compression depth was slightly deeper in Coaching group (43.0mm vs 41.5mm, p=0.695). When compared the average depth of the first 10 compressions to the total average in each group, the depth significantly improved in Coaching group while that decreased in No Coaching Groups (38.4mm to 43.0mm; p=0.020, 42.3mm to 41.5mm; p=0.431, respectively). The chest compression fraction was also high in Coaching Group (99.4% vs 93.0%, p=0.005). Conclusions: Participants in Coaching Group performed better CPR compared to No Coaching Group in terms of high flow fraction. Although the average compression depth was below the guideline recommendation in both groups, it significantly improved in Coaching group. This study indicates that dispatch coaching can optimize the performance of bystander CPR.

Abstract 231: Single Bystander CPR Performance During Drone AED Delivery for Simulated Out of Hospital Cardiac Arrest

Background: Drones have great potential to speed the delivery of AEDs in the critical first few minutes of OHCA. However, it is unclear whether bystanders can balance high-quality cardiopulmonary resuscitation (CPR) with AED deployment. The 2015 AHA CPR guidelines recommend a chest compression (cc) rate of 100-120/minute, cc depth of 50-60mm, and cc fraction of &gt;60%. Method: We performed mock cardiac arrest simulations using bystander volunteers, including simulated 911 call, telephone-assisted dispatcher CPR instructions, bystander CPR, drone-delivered AED, and AED application. CPR performance was recorded by a Laerdal Resusci Anne Quality Feedback System and compared between two groups of participants: recent CPR training (&lt;2 years) versus remote (&gt;2 years) or no CPR training. Prior data had shown CPR skill degradation after 2 years. Chi-squared tests compared demographics; T-tests compared age and CPR performance data. Results: Between 9/2019-3/2020, 5 simulations were conducted with 51 participants. The mean age was 39.7 years, 56.9% were female, and 78.4% had a college or graduate degree. Racial/ethnic makeup consisted of 64.7% White, 15.7% African-American, 15.7% Asian, and 11.8% Hispanic. 41.2% had recent CPR training (n=21); 58.8% had remote CPR training (n=19) or no CPR training (n=11). There were no differences in demographics by CPR training groups. Participants with recent CPR training had shorter time from CPR initiation to AED shock delivery (3:45 vs. 4:14 [min:sec], p=0.01) and a trend toward higher percent of time with cc depth (77.4% vs 50.4%, p=0.11) and higher cc fraction (46.8% vs 42.9 %, p=0.12). There were no differences for percent of time with cc rate or CPR recoil. Conclusion: Overall, CPR quality was low regardless of prior CPR training status. Those recently trained had shorter resuscitation time and appeared to have better CPR performance. Realization of a drone AED networks may require novel CPR programs focused on high-quality CPR.

Predictors of mortality in patients with VA-extracorporeal membrane oxygenation

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is a lifesaving tool used in the treatment of cardiogenic shock, acute heart failure, or extracorporeal cardiopulmonary resuscitation (CPR). We report on a single center experience with ECMO and aim to identify the prognostic markers for in-hospital mortality and death at 72 hours after ECMO. Methods Between 2011 and 2019 we evaluated 131 patients, who received ECMO. Collected data was analyzed to identify baseline characteristic, outcomes including clinical variables predictive of poor outcome. Results The mean age was 62.5 years, 67.2% were male patients, with prior CPR in 61.8%. The annual number of VA-ECMO procedures steadily increased, whereas in-hospital mortality is decreasing. Within the total cohort, the indication for VA-ECMO was cardiac arrest in 19.1%, acute coronary syndrome in 41.2%, acute heart failure in 23.7%, and myocarditis in 10.7%. Overall in-hospital mortality was 58.8%. Multivariate logistic regression model revealed presence of malignancy, history of revascularization, duration of cardiac arrest, and low BMI as independent predictors for mortality in 72 hours after ECMO (table). On the other hand, predictors of in-hospital mortality were prior congestive heart failure, male, and history of malignancy. The C-statistic for discriminating mortality in 72 hours after ECMO with the duration of cardiac arrest was 0.67 (figure). Conclusions Although the use of ECMO as a last line in the treatment of critical patients measures constitutes an important improvement in their care; with 41.2% overall survival; patient selection and timing of ECMO initiation remains challenging. The importance of consideration for ECMO use earlier in course of illness rather than later. Funding Acknowledgement Type of funding source: None

Public perception towards bystander cardiopulmonary resuscitation

ObjectiveBystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA) improves survival and neurological outcomes. Nonetheless, many OHCA patients do not receive bystander CPR during a witnessed arrest. Our aim was...

Triage Performance of School Personnel Using the SALT System.

The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n=104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD=10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.

Evaluation of a Neonatal Resuscitation Curriculum in Liberia.

Neonatal mortality in Africa is among the highest in the world. In Liberia, providers face significant challenges due to lack of resources, and providers in referral centers need to be prepared to appropriately provide neonatal resuscitation. A team of American Heart Association health care providers taught a two-day neonatal resuscitation curriculum designed for low-resource settings at a regional hospital in Liberia. The goal of this study was to evaluate if the curriculum improved knowledge and comfort in participation. The curriculum included simulations and was based on the Neonatal Resuscitation Protocol (NRP). Students learned newborn airway management, quality chest compression skills, and resuscitation interventions through lectures and manikin-based simulation sessions. Seventy-five participants were trained. There was a 63% increase in knowledge scores post training (p < 0.00001). Prior cardiopulmonary resuscitation (CPR) training, age, occupation, and pre-intervention test score did not have a significant effect on post-intervention knowledge test scores. The median provider comfort score improved from a 4 to 5 (p < 0.00001). Factors such as age, sex, prior NRP education, occupation, and post-intervention test scores did not have a significant effect on the post-intervention comfort level score. A modified NRP and manikin simulation-based curriculum may be an effective way of teaching health care providers in resource-limited settings. Training of providers in limited-resource settings could potentially help decrease neonatal mortality in Liberia. Modification of protocols is sometimes necessary and an important part of providing context-specific training. The results of this study have no direct relation to decreasing neonatal mortality until proven. A general resuscitation curriculum with modified NRP training may be effective, and further work should focus on the effect of such interventions on neonatal mortality rates in the region.

Abstract 194: Public Perception Towards Out-of-Hospital Cardiac Arrest Victims: Potential Reasons Influencing the Decision to Perform Bystander Cardiopulmonary Resuscitation

Background: Bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA) improves survival and neurological outcomes. Unfortunately many OHCA victims do not receive bystander CPR during a witnessed arrest. It is known that gender disparities play a role with lower rates of bystander CPR in women suffering OHCA in public places. Our aim was to identify potential factors influencing the decision to perform bystander CPR. Methods: Participants at CPR training events were surveyed prior to training. Using different scenarios, subjects were asked about their comfort level performing CPR on female, geriatric, and pediatric victims. Anonymous responses were collected and transformed into categorical variables by a psychometrist. Results: Of the 677 participants, 585 (86.4%) responded the survey, with 87.5% between 18-29 years of age, 58.8% without prior CPR training and 93.3% without prior CPR experience. Reasons to hesitate starting bystander CPR in women included concern about exposing the victim (12.9%), being accused of sexual assault (6.1%), and possible pregnancy (6.5%). In participants with prior CPR training, 61.1% reported concerns about performing CPR on women, with 18.9% having concerns about performing chest compressions in relation to breast location. In participants without prior CPR training, 73.2% reported having concerns about performing CPR on women. Causing injury and exposing the patient were top concerns to perform CPR in women amongst participants who were uncomfortable (30.5% and 17.5% respectively) and comfortable (14.5% and 9.8% respectively) performing CPR in public. Causing injury was the top concern in performing CPR on geriatric (45.4%) and pediatric patients (41.7%), followed by fragility (18.1% and 10.2% respectively). Lack of skills to perform CPR on children was reported in 22% of CPR-trained participants. Conclusion: Public perception of OHCA victims influences willingness to perform bystander CPR. Factors such as age, gender, fear of injury, pregnancy status and sexual assault concerns can negatively impact this life saving intervention. Awareness of the importance of bystander CPR on any cardiac arrest victim must be improved.

Abstract 226: Comparison of a Low and High Resource Model to Effectively Train College Students in Compression Only Cardiopulmonary Resuscitation

Introduction: High quality chest compressions, as measured by depth and rate per minute, are an integral component of cardiopulmonary resuscitation (CPR). CPR compression skills are often taught on a high resource training device such as manikin torso. Use of these manikin torso devices may be limited by availability and cost, reducing the number of individuals trained in CPR. We hypothesize that a bed pillow, a low resource device, is as effective as a manikin torso, a high resource device, in training college students to perform compression only CPR. Methods: College students with no prior CPR training were randomized to one of two training rooms, one with a bed pillow (n=119) and one with a manikin torso (n=123). Each participant watched a two- minute training video, which included a demonstration using the respective device and a practice-while-watching technique chest compression skills practice. Each room had a certified CPR instructor to assist and answer any technical questions. Another CPR instructor, blinded to the training randomizations, observed each participant for one minute on a recording manikin that evaluated the depth and rate of compressions. Results: Manikin-trained students had a significantly higher mean rate of compressions per minute compared to the pillow-trained students (122.9 vs. 118.0; p= 0.028). The manikin group exceeded the recommended rate range (100-120 compressions per minute). There was no significant difference between compression depth in the two groups; manikin-trained students had an average compression depth of 38.27 mm while pillow-trained students had an average compression depth of 38.50 mm (p=0.89). Mean compression depth for both groups were below the guidelines (50-61 mm).There was no significant difference (p=0.81) between the overall CPR competency of the pillow-trained compared to the manikin-trained students as measured by rate and depth of compressions. Conclusions: These findings demonstrate that a low resource pillow is comparable to a high resource manikin as a CPR training device. The use of a low resource training device can remove the barriers of cost and availability in training college students in CPR. This training method will allow for an increase in the number of people trained to save lives.