Prior Cardiopulmonary Resuscitation Research Articles

Acute, total occlusion of the left main stem: coronary intervention options, outcomes, and recommendations.

IntroductionAcute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce.AimTo examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo.Material and methodsData on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE).ResultsAbout 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in > 85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%.ConclusionsWe found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.

The Effects of Knowledge, Attitude, and Self-efficacy of CPR on Willingness to Perform CPR in Family Members of Patients with Heart Disease

Purpose: The purpose of this study was to investigate the effects of knowledge, attitude, and self-efficacy of cardiopulmonary resuscitation (CPR) and the willingness of family members to perform the CPR to their loved one with heart disease. Methods: 226 participants whose family member is hospitalized with heart disease were recruited from two hospitals in Daegu city. Data were collected by using questionnaires which included demographic characteristics, factors including knowledge, attitude, and self-efficacy and the willingness to perform CPR. Results: Participants reported on their level of knowledge, attitude, and self-efficacy of CPR at the following levels: 9.16±2.66, 35.55±5.56, and 63.83±19.37 respectively. Only 53% of the participants reported prior CPR training, and 67.7% indicated that they would be willing to perform CPR to their family member with heart disease. Of the participants without prior CPR training, 34% reported that they did not recognize the importance of CPR training. Participants reported attitude (p=.002) and self-efficacy (p=.040) predicted willingness to perform CPR. Age (p<.001), gender (p=.004), educational level (p<.001), occupation (p<.001), prior CPR training (p<.001) were related to willingness to perform CPR. Conclusion: This study findings suggest that it is necessary to develop educational programs for public to improve competent CPR performance.

Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study

BackgroundThe present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linked to a ventilator and provides synchronised visual and acoustic instructions for guidance through the ALS algorithm and assistance for face-mask ventilations.MethodsWe compared the cardiopulmonary resuscitation (CPR) quality of emergency medical system (EMS) staff members using the study device or standard equipment in a mannequin simulation study with a prospective, controlled, randomised cross-over study design. Main outcome was the effect of the study device compared to the standard equipment and the effect of the number of prior ALS trainings of the EMS staff on the CPR quality. Data were analysed using analyses of covariance (ANCOVA) and binary logistic regression, accounting for the study design.ResultsIn 106 simulations of 56 two-person rescuer teams, the mean hands-off time was 24.5% with study equipment and 23.5% with standard equipment (Difference 1.0% (95% CI: −0.4 to 2.5%); p = 0.156). With both types of equipment, the hands-off time decreased with an increasing cumulative number of previous CPR trainings (p = 0.042). The study equipment reduced the mean time until administration of adrenaline (epinephrine) by 23 s (p = 0.003) and that of amiodarone by 17 s (p = 0.016). It also increased the mean number of changes in the person doing chest compressions (0.6 per simulation; p < 0.001) and decreased the mean number of chest compressions (2.8 per minute; p = 0.022) and the mean number of ventilations (1.8 per minute; p < 0.001). The chance of administering amiodarone at the appropriate time was higher, with an odds ratio of 4.15, with the use of the study equipment CPR.com compared to the standard equipment (p = 0.004). With an increasing number of prior CPR trainings, the time intervals in the ALS algorithm until the defibrillations decreased with standard equipment but increased with the study device.ConclusionsEMS staff with limited training in CPR profit from guidance through the ALS algorithm by the study device. However, the study device somehow reduced the ALS quality of well-trained rescuers and thus can only be recommended for ALS provider with limited experience.

Troponin levels in patients with stable CAD

IntroductionCardiac troponins are known as specific markers of myocardial damage. Their elevation in the serum is not always related to acute myocardial ischaemia. The increased sensitivity of diagnostic kits has resulted in an increase in the number of positive results in patients without acute coronary syndrome (ACS). Study objectivesTo determine the level of highly sensitive troponin T (hs TnT) in stable patients (without ACS) before selective coronarography (SCG) and to determine the correlation between hs TnT values and the extent of atherosclerotic damage to the coronary arteries. MethodologyWe studied a group of 251 consecutive patients with indications for SCG diagnosis. Indication criteria were stable angina pectoris, shortness of breath, newly diagnosed heart failure, syncope, and ventricular arrhythmia. Exclusion criteria were acute coronary syndrome, including unstable angina pectoris, prior cardiopulmonary resuscitation, cerebrovascular accident (CVA) within the last 6 months, and ongoing sepsis. The hs TnT value was determined before SCG (normal range, 0–0.013μg/l). Monitored parameters included coronary angiography (70% stenosis of coronary artery diameter was considered significant coronary disease), age, gender, heart rate, and serum creatinine levels. The study included 182 patients with normal renal function and 69 patients with renal insufficiency. The results were processed using STATISTICA (version 12), StatSoft©, Inc. (2013). ResultsThe average age of the studied population was 69.6±10.3 years (median, 70 years); 33% of patients were women. The serum level of hs TnT for the entire population was 0.031±0.091μg/l (0.014). A positive hs TnT was noted in 133 patients. The population study group consisted of 121 patients with normal coronary arteries or with insignificant atherosclerotic disease. Significant damage involving one or more arteries was present in 130 patients. In the subgroup with significant coronary disease, we found a significantly higher hs TnT level than in the group of patients without significant coronary disease: 0.043±0.125μg/l (0.018) vs. 0.019±0.018μg/l (0.013) (p=0.008) (Mann–Whitney test).Significantly higher troponin levels were found in the group of patients with renal insufficiency than in the subgroup with normal creatinine levels: 0.057±0.150μg/l (0.023) vs. 0.022±0.053μg/l (0.012), respectively (p<0.05) (Mann–Whitney test). ConclusionSlightly elevated serum troponin T levels are common in patients with stable coronary artery disease (CAD). We observed a significant correlation between the level of troponin and the presence of atherosclerotic damage to the coronary arteries. A significant correlation between the value of troponin and the extent of atherosclerotic damage (in terms of the number of damaged arteries) could not be demonstrated. On the basis of our findings, the absolute level of troponin T in patients with stable CAD must be interpreted with caution, especially in patients who also have renal insufficiency. Determination of basal troponin T levels in patients with stable CAD is reasonable as they may be used for comparison in case of change in a patient's clinical condition.

Community involvement in out of hospital cardiac arrest: A cross-sectional study assessing cardiopulmonary resuscitation awareness and barriers among the Lebanese youth.

Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival.This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR.A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR.A total of 948 students completed the survey. Participants’ mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR.University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of bystander CPR and the need to learn CPR is very positive. Interventions should focus on public awareness campaigns regarding the importance of initiating bystander CPR while activating emergency medical services (EMS) and on making CPR training more available.

Barriers and Facilitators to Community CPR Education in San José, Costa Rica

Bystander cardiopulmonary resuscitation (CPR) improves survival after prehospital cardiac arrest. While community CPR training programs have been implemented across the US, little is known about their acceptability in non-US Latino populations. The purpose of this study was to identify barriers to enrolling in CPR training classes and performing CPR in San José, Costa Rica. After consulting 10 San José residents, a survey was created, pilot-tested, and distributed to a convenience sample of community members in public gathering places in San José. Questions included demographics, CPR knowledge and beliefs, prior CPR training, having a family member with heart disease, and prior witnessing of a cardiac arrest. Questions also addressed barriers to enrolling in CPR classes (cost/competing priorities). The analysis focused on two main outcomes: likelihood of registering for a CPR class and willingness to perform CPR on an adult stranger. Odds ratios and 95% CIs were calculated to test for associations between patient characteristics and these outcomes. Among 371 participants, most were male (60%) and <40 years old (77%); 31% had a college degree. Many had family members with heart disease (36%), had witnessed a cardiac arrest (18%), were trained in CPR (36%), and knew the correct CPR steps (70%). Overall, 55% (95% CI, 50-60%) indicated they would "likely" enroll in a CPR class; 74% (95% CI, 70-78%) would perform CPR on an adult stranger. Cardiopulmonary resuscitation class enrollment was associated with prior CPR training (OR: 2.6; 95% CI, 1.6-4.3) and a prior witnessed cardiac arrest (OR: 2.0; 95% CI, 1.1-3.5). Willingness to perform CPR on a stranger was associated with a prior witnessed cardiac arrest (OR: 2.5; 95% CI, 1.2-5.4) and higher education (OR: 1.9; 95% CI, 1.1-3.2). Believing that CPR does not work was associated with a higher likelihood of not attending a CPR class (OR: 2.4; 95% CI, 1.7-7.9). Fear of performing mouth-mouth, believing CPR is against God's will, and fear of legal risk were associated with a likelihood of not attending a CPR class and not performing CPR on a stranger (range of ORs: 2.4-3.9). Most San José residents are willing to take CPR classes and perform CPR on a stranger. To implement a community CPR program, barriers must be considered, including misgivings about CPR efficacy and legal risk. Hands-only CPR programs may alleviate hesitancy to perform mouth-to-mouth. Schmid KM , Mould-Millman NK , Hammes A , Kroehl M , Quiros García R , Umaña McDermott M , Lowenstein SR . Barriers and facilitators to community CPR education in San José, Costa Rica. Prehosp Disaster Med. 2016;31(5):509-515.

Abstract 12035: Effect of 10-minute Dispatch-Assisted Cardiopulmonary Resuscitation Training in Addition to a Standard Course: A 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 (DA-CPR), which can double the frequency of bystander CPR. Laypersons, however, are not familiar with how dispatchers provide CPR instructions. DA-CPR training may be effective at spreading DA-CPR, but this needs to be validated. The aim of this study was to determine the effectiveness of brief DA-CPR training in addition to a standard CPR training course. Methods: We conducted a DA-CPR simulation study. Participants with no prior CPR training within 1 year were assigned randomly to one of two 90-min CPR training courses (DA-CPR Group: a standard CPR course with 10-min DA-CPR training or Standard Group: a standard CPR course with a simple introduction to how dispatchers deal with emergency calls). In the DA-CPR Group, the participants practiced the role of a dispatcher and an emergency caller. At 6 months after training, the subjects performed CPR for 2 min under instruction from off-duty dispatchers. Results: Of the 66 participants, 59 (DA-CPR Group, 30; Standard Group, 29) completed the simulation at 6 months after training. The median time intervals between call receipt and cardiac arrest recognition or instruction for chest compressions by dispatchers were similar between both groups. However, the subjects in the DA-CPR Group provided the first compression more quickly (median time interval between call receipt and the first dispatch-assisted compression: 108 vs. 129 s, respectively, p &lt; 0.05 Mann-Whitney U test). The quality of chest compressions was, however, similar between both groups. Conclusions: All participants could perform DA-CPR at 6 months after training, but those in the DA-CPR Group started chest compressions more quickly. DA-CPR training might be effective for the immediate development of better cooperation between a layperson and a dispatcher.

Perception of CPR quality: Influence of CPR feedback, Just-in-Time CPR training and provider role

AimMany healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. MethodsWe conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. ResultsParticipants overestimated achieving adequate chest compression depth (mean difference range: 16.1–60.6%) and rate (range: 0.2–51%), and underestimated chest compression fraction (0.2–2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (p<0.001). Accurate estimation of CPR quality was poor for chest compression depth (0–13%), rate (5–46%) and chest compression fraction (60–63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback. ConclusionHealthcare providers’ visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training.

Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR

IntroductionWe investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR. MethodsIn 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children. ResultsA total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n=822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P<0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively. ConclusionsInstructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren.

Evaluation of a new semiautomated external defibrillator technology: a live cases video recording study

AimTo determine the effect of a new automated external defibrillator (AED) system connected by General Packet Radio Service (GPRS) to an external call centre in assisting novices in a sudden...

Protective and biogenesis effects of sodium hydrosulfide on brain mitochondria after cardiac arrest and resuscitation

Mitochondrial dysfunction plays a critical role in brain injury after cardiac arrest and cardiopulmonary resuscitation (CPR). Recent studies demonstrated that hydrogen sulfide (H2S) donor compounds preserve mitochondrial morphology and function during ischemia-reperfusion injury. In this study, we sought to explore the effects of sodium hydrosulfide (NaHS) on brain mitochondria 24h after cardiac arrest and resuscitation. Male Sprague-Dawley rats were subjected to 6min cardiac arrest and then resuscitated successfully. Rats received NaHS (0.5mg/kg) or vehicle (0.9% NaCl, 1.67ml/kg) 1min before the start of CPR intravenously, followed by a continuous infusion of NaHS (1.5mg/kg/h) or vehicle (5ml/kg/h) for 3h. Neurological deficit was evaluated 24h after resuscitation and then cortex was collected for assessments. As a result, we found that rats treated with NaHS revealed an improved neurological outcome and cortex mitochondrial morphology 24h after resuscitation. We also observed that NaHS therapy reduced intracellular reactive oxygen species generation and calcium overload, inhibited mitochondrial permeability transition pores, preserved mitochondrial membrane potential, elevated ATP level and ameliorated the cytochrome c abnormal distribution. Further studies indicated that NaHS administration increased mitochondrial biogenesis in cortex at the same time. Our findings suggested that administration of NaHS 1min prior CPR and followed by a continuous infusion ameliorated neurological dysfunction 24h after resuscitation, possibly through mitochondria preservation as well as by promoting mitochondrial biogenesis.

Effect of prior cardiopulmonary resuscitation knowledge on compression performance by hospital providers.

IntroductionThe purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest.MethodsThis cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin.ResultsData from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (μ=117 vs. 94, p<0.001). Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (μ=86% vs. 72%, p<0.01). No significant differences were found in depth or recoil performance based on knowledge of guidelines.ConclusionKnowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

Training Mothers in Infant Cardiopulmonary Resuscitation With an Instructional DVD and Manikin

Classes in infant cardiopulmonary resuscitation (CPR) can be time consuming and costly. To determine whether mothers in an obstetric unit could learn infant CPR by using a 22-minute instructional kit and to assess the value and confidence they gained by learning CPR. Quasi-experimental study with enrollment between January and December 2008. Obstetric unit in Lehigh Valley Hospital, a suburban teaching hospital in Allentown, Pennsylvania. Mothers at least 18 years old who had given birth within the previous 24 hours. The experimental group included mothers without prior CPR training who watched a 22-minute instructional DVD and practiced on a manikin. The control group included mothers with prior conventional CPR training. In both groups, knowledge and proficiency were assessed with written and practical examinations developed by certified CPR instructors. Participant surveys were conducted at 3 times: immediately before dissemination of course materials, within 24 hours after the mother agreed to participate in the study, and 6 months after initial evaluation. A total of 126 mothers were enrolled in the study: 79 in the experimental group, 25 in the control group, and 22 who withdrew from the study. Written and practical examinations were used to determine proficiency, and composite scores were generated, with a maximum composite score of 12. The composite scores were statistically significantly higher in the experimental group than in the control group, with median scores of 10 and 7, respectively (P<.001). Twenty-two mothers (21%) had been previously offered CPR training. In the experimental group, 76 mothers (96%) felt more confident as caregivers after learning CPR. Before training in both groups, 84 mothers (81%) stated that learning CPR was extremely important, compared with 100 mothers (96%) after training (P=.001). Use of an instructional kit is an effective method of teaching CPR to new mothers. Mothers reported that learning CPR is extremely important and that it increases their confidence as caregivers.

Barriers and facilitators to CPR knowledge transfer in an older population most likely to witness cardiac arrest: a theory-informed interview approach

We sought to identify perceived barriers and facilitators to cardiopulmonary resuscitation (CPR) training and performing CPR among people above the age of 55 years. We conducted semistructured qualitative interviews with a purposive sample of independent-living individuals aged 55 years and older from urban and rural settings. We developed an interview guide based on the constructs of the Theory of Planned Behaviour, which elicits salient attitudes, social influences and control beliefs potentially influencing CPR training and performance. Interviews were recorded, transcribed verbatim and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging themes, and ranked them by way of consensus. Demographics for the 24 interviewees: mean age 71.4 years, women 58.3%, urban location 75.0%, single dwelling 58.3%, CPR training 79.2% and prior CPR on real victim 8.3%. Facilitators of CPR training included: (1) classes in a convenient location; (2) more advertisements; and (3) having a spouse. Barriers to taking CPR training included: (1) perception of physical limitations; (2) time commitment; and (3) cost. Facilitators of providing CPR included: (1) 9-1-1 CPR instructions; (2) reminders/pocket cards; and (3) frequent but brief updates. Barriers to providing CPR included: (1) physical limitations; (2) lack of confidence; and (3) ambivalence of duty to act in a large group. We identified key facilitators and barriers for CPR training and performance in a purposive sample of individuals aged 55 years and older.

The effect of ventricular fibrillation time and NYHA classification on defibrillation in intensive care unit patients

To investigate whether the sequence of defibrillation (DF) and cardiopulmonary resuscitation (CPR), duration of ventricular fibrillation (VF), and New York Heart Association (NYHA) classification would affect DF result in intensive care unit. Ninety-three cases needing instantaneous DF were divided into three groups according to VF lasting time: <4 minute group (n=53), 4 - 8 minute group (n=24), >8 minute group (n=16), and each group was randomly divided into two sub-groups according to time sequence: the prior DF group or the prior CPR for five cycles followed by DF group (prior CPR group). The effect of VF time, the sequence of DF and CPR, and NYHA classification on success rate of DF were observed. With prolonging VF time, success rate of DF obviously lowered [success rate of DF for VF<4 minute, 4 - 8 minute, and >8 minute groups were 83.0% (44/53), 62.5% (15/24), and 25.0% (4/16), respectively, all P<0.01]. When VF time lasted less than 4 minutes, success rate of DF in the prior DF group was obviously higher than that in the prior CPR group [88.9% (24/27) vs. 76.9% (20/26), P<0.05]. When VF time lasted for 4 - 8 minutes, the prior DF group had slightly higher success rate of DF compared with the prior CPR group [66.7% (8/12) vs. 58.3% (7/12), P=0.09]. When VF time lasted longer than 8 minutes, the success rate of DF in the prior CPR group was obviously higher than that in the prior DF group [37.5% (3/8) vs. 12.5% (1/8), P<0.01]. The success rate of DF was lowered in higher NYHA classification [success rate of DF for NYHA classification I-IV was 96.4% (27/28), 80.0% (20/25), 47.8% (11/23), 29.4% (5/17), respectively, P<0.05 or P<0.01]. VF lasting time and NYHA classification are key factors to success rate of DF, and the choice of sequence of DF and CPR depends on the lasting time of VF. For cases with the high NYHA classification, we should make some judgement beforehand and prepare some preventive measures.

Abstract 9940: A Survey on Laypersons' Willingness in Performing Cardiopulmonary Resuscitation

Introduction Although bystander cardiopulmonary resuscitation (CPR) can more than double survival from cardiac arrest, the reported prevalence of bystander CPR remains low in most countries. Reasons cited for the reluctance to perform CPR often include concerns about disease transmission related to performing mouth-to-mouth ventilation. However, a couple of studies reported that bystanders at the scene of out-of-hospital cardiac arrests most often cited other reasons such as panic or fear of causing harm for failing to perform CPR. This study was performed to investigate factors affecting laypersons' willingness in performing CPR. Methods Questionnaires including 10 questions regarding personnel backgrounds, knowledge regarding the use of AED, CPR training, willingness in performing CPR, and EMS dispatcher's phone advice were distributed to citizens who gathered at a ball park stadium, a typical public place in Hiroshima, Japan. Results Ten thousands questionnaires were distributed and a total of 5,956 were collected for analysis. As for the willingness to perform CPR, 38 % answered they would start CPR, 34 % would do it if any advice available. On the other hand, 23 % said they were not capable of performing CPR, and 4 % were not willing to do it. Of those who were not capable of performing CPR, the reasons included lack of knowledge and/or skills to perform CPR (50%), no previous CPR training (27%), and concern over harm to the victims (25%).Of those who were willing to perform CPR, 61 % answered they would prioritize rescue breathing over chest compression. In comparison of those with and without previous CPR training or knowledge of the use of AED, a significant differences were found in the willingness in performing CPR (88% vs. 58%, p &lt;0.0001; 91% vs. 58%, p &lt;0.0001, respectively), and doing rescue breathing (55% vs. 29%, p &lt;0.0001; 64% vs. 57%, p &lt;0.0001, respectively). Fifty two percent of the respondents did not know the service of dispatcher-assisted CPR. Conclusion Our study indicated that proper knowledge of CPR, prior CPR training, and on-site bystander CPR assistance may greatly enhance laypersons' willingness in performing CPR. More emphasis should be exerted on the roles of chest compression and the EMS dispatcher-assistance in CPR education.

A different rescuer changing strategy between 30:2 cardiopulmonary resuscitation and hands-only cardiopulmonary resuscitation that considers rescuer factors: A randomised cross-over simulation study with a time-dependent analysis

AimTo compare the time-dependent changes in the quality of chest compressions in 30:2 cardiopulmonary resuscitation (CPR) and hands-only cardiopulmonary resuscitation (HO-CPR) and to evaluate how individual rescuer factors affect the quality of chest compressions over time for both CPR techniques. MethodsTotal 1028 adult hospital and university workers participated in CPR training programs including sessions of 30:2 CPR and HO-CPR. Tests of both CPR methods were performed in a random order using a manikin with Skill-Reporter™. Data were collected from 863 subjects. The time-dependent changes in chest compressions quality and the effects of individual rescuer factors (age, gender, body mass index (BMI), prior CPR training and experience) were analysed using the general linear model for a repeated-measures procedure. ResultsIn HO-CPR, the mean proportion of correct compressions depth (MPCD) decreased significantly throughout the time sectors following 20–40s (74.4–50.4% in 100–120s) compared to 30:2 CPR (83.4–76.3% in 100–120s) (p<0.0001). A significant decline of MPCD (MPCD<70%) was initially observed at 40–60s in HO-CPR, however, this pattern was not observed in 30:2 CPR. Individual rescuer factors minimally affected the time-dependent change in MPCD during 30:2 CPR. For HO-CPR, all rescuer factors except for male or obese/overweight (BMI≥25) were associated with a significant declines of MPCD, and these decline were usually observed from 40 to 60s. ConclusionSwitching rescuers at an interval of 2-min is reasonable for 30:2 CPR. However, for HO-CPR switching rescuers every 1-min may be preferable except when rescuers are male or obese/overweight (BMI≥25).

The effect of socioeconomic status on mortality in the critically ill: A national data linkage study

BackgroundAdmission to intensive care units (ICUs) is determined by degree of organ failure and the need for close monitoring. It is associated with high intensity, expensive treatments. Socioeconomic status (SES)...

A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: The two-person CPR study

Study AimThe primary purpose of this study was to compare two, shorter, self-directed methods of cardiopulmonary resuscitation (CPR) education for healthcare professionals (HCP) to traditional training with a focus on the trainee's ability to perform two-person CPR. MethodsFirst-year medical students with either no prior CPR for HCP experience or prior training greater than 5 years were randomized to complete one of three courses: 1) HeartCode BLS System, 2) BLS Anytime, or 3) Traditional training. Only data from the adult CPR skills testing station was reviewed via video recording by certified CPR instructors and the Laerdal PC Skill Reporter software program (Laerdal Medical, Stavanger, Norway). ResultsThere were 180 first-year medical students who met inclusion criteria: 68 were HeartCode BLS System, 53 BLS Anytime group, and 59 traditional group Regarding two-person CPR, 57 (84%) of Heartcode BLS students and 43 (81%) of BLS Anytime students were able to initiate the switch compared to 39 (66%) of traditional course students (p=0.04). There were no significant differences in the quality of chest compressions or ventilations between the three groups. There was a trend for a much higher CPR skills testing pass rate for the traditional course students. However, failure to “clear to analyze or shock” while using the AED was the most common reason for failure in all groups. ConclusionThe self-directed learning groups not only had a high level of success in initiating the “switch” to two-person CPR, but were not significantly different from students who completed traditional training.

Acute Treatment of ST-Segment-Elevation Myocardial Infarction: Is There a Role for the Cardiac Surgeon?

Several attempts from single institutions to treat acute myocardial infarctions with bypass surgery never reached widespread acceptance in the cardiology and surgical community. Owing to a variety of new surgical techniques, this old dogma has to be reconsidered under the light of patient-adjusted optimal treatment algorithms. Between August 2002 and August 2007, 112 patients, mean age of 66 years (range, 41 to 85 years), underwent emergency coronary artery bypass grafting (untreatable or rejected by the referring cardiologists within 48 hours after onset of symptoms). Thirty-seven patients (33%) exhibited cardiogenic shock, and 18 (16%) had prior cardiopulmonary resuscitation. Preoperative support by intraaortic balloon pump was initiated in only 10%, and 65% had left main stem stenosis. All patients showed a significant elevation of cardiac markers (creatine kinase-MB) and ST-segment elevation. The mean number of grafts was 2.4 (range, 1 to 4). The cardiopulmonary bypass time ranged from 48 to 261 minutes. Intraaortic balloon pump for weaning from extracorporeal circulation was used in 42 patients (38%); 3 patients needed extracorporeal membrane oxygenation support. Postoperative complications included rethoracotomy for bleeding in 4% and stroke in 2%. Thirty-day mortality was 20% in the whole group, 30% in the group with cardiogenic shock, and 15% in those without hemodynamic deterioration (p = 0.044). The multivariate analysis revealed the preoperative need for catecholamines as the only risk factor for 30-day mortality (odds ratio, 6.4; 95% confidence interval, 2 to 21; p = 0.002). Emergency coronary artery bypass grafting in patients with acute myocardial infarction can be performed with acceptable results, especially in those without cardiogenic shock. Therefore, operative revascularization should not be considered only as a rescue therapy.