Quality Of Cardiopulmonary Resuscitation Research Articles

Effectiveness of team-focused CPR on in-hospital CPR quality and outcomes

ObjectiveWe sought to identify changes in neurological outcome over time following initial training and subsequent implementation of team-focused CPR in an inpatient setting where responders practice specific roles with emphasis on minimally interrupted chest compressions and early defibrillation. MethodsThis retrospective pre- vs post-intervention study was conducted at an urban 900-bed teaching hospital and Level I Cardiac Resuscitation Center. We included adult patients suffering in-hospital cardiac arrest occurring in non-emergency department and non-intensive care unit areas who received CPR and/or defibrillation. We compared survival with good neurological outcome at time of hospital discharge in the one-year periods before and after implementation of team-focused CPR. To investigate skill degradation, we compared cumulative survival with good neurological outcome in 3-month intervals against the before team-focused CPR baseline. Trained research associates abstracted explicitly defined variables from electronic health records using a standardized form and data dictionary to achieve consistency between collaborators. ResultsOf 296 IHCAs, 207 patients met inclusion criteria and were analyzed. In 104 patients before team-focused CPR initiation, survival with good neurological outcome was 21%. In the 12-month period following team-focused CPR initiation, survival with good neurological outcome was 31% in 101 patients, risk difference 9.9% (95% CI −2 to 22%; p = 0.14). By quarterly time intervals, following team-focused CPR implementation, the cumulative survival with good neurological outcome at 3 months was 42%; at 6 months 37%; at 9 months 31%; and at 12 months 31%. ConclusionIn our single-institution implementation of team-focused CPR for in-hospital cardiac arrest, outcomes significantly improved at 6 months before declining towards baseline.

Drone-facilitated real-time video-guided feedback helps to improve the quality of lay bystander basic life support. A randomized controlled simulation trial

ABSTRACT Objectives: Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR. Methods: We used a randomized controlled simulation trial. Lay rescuers performed 8 minutes of CPR on an objective feedback manikin. Participants were randomized to receive telephone instructions with (intervention group) or without (control group) a drone providing a visual connection with the telecommunicator after a 2-minute run-in phase. Performed work (total compression depth minus total lean depth) was the primary outcome. Secondary outcomes were the proportion of effective chest compressions, average compression depth, subjective physical strain every two minutes, and dexterity in the nine-hole peg test after the scenario. Outcomes were compared using the t- and Mann Whitney-U tests. A two-sided p-value of <0.05 was considered significant. Results: We included 27 individuals (14 (52%) female, mean age 41 ± 14 years). Performed work was greater in the drone than in the control group (41.3 ± 7.0 vs. 33.9 ± 10.9 m; absolute difference 7.5, 95% CI 1.4 to 14.8; p = 0.046), with higher average compression depth (49 ± 7 vs. 40 ± 13 mm; p = 0.041), and higher proportions of adequate chest compressions (43 (IQR 14–60) vs. 3 (0–29) %; p = 0.041). We did not find any significant differences regarding the remaining secondary outcomes. Conclusion: Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.

Analysis of Nurses Knowledge and Motivation for the Implementation of Cardiopulmonary Resuscitation at Kaimana Hospital

Background: In carrying out cardiopulmonary resuscitation actions, compression accuracy and compression speed are required to be correct and appropriate in order to create a quality cardiopulmonary resuscitation series. Therefore, nurses' knowledge and motivation are needed in carrying out cardiopulmonary resuscitation. Purpose: This research aims to determine the relationship between knowledge, motivation and accuracy in carrying out cardiopulmonary resuscitation. Method: This research uses a descriptive correlation research design with a cross sectional approach. With a purposive sampling technique, a sample of 49 respondents was obtained, the independent variables were knowledge and motivation, the dependent variable was cardiopulmonary resuscitation, using a questionnaire and observation sheet. The chi-square test was used to determine the relationship between the two variables. Results: The results of research from 49 respondents showed that the majority of respondents had moderate knowledge of 73.5%, moderate motivation of 59.2% and inappropriate RJP actions of 85.7%. Analysis using the chi-square statistical test on knowledge and motivation towards the implementation of cardiopulmonary resuscitation resulted in p = 0.000 ˂ 0.05, which means there is a relationship between knowledge and motivation towards the implementation of cardiopulmonary resuscitation measures. Conclusion: Knowledge has more influence on the implementation of RJP when compared to motivation, but in reality the level of knowledge is mostly in the medium category so it has an impact on the quality of RJP actions. The results will greatly influence health services to patients. Therefore, it must be supported by continuous learning or training in RJP techniques.

The association of recent simulation training and clinical experience of team leaders with cardiopulmonary resuscitation quality during in-hospital cardiac arrest

ObjectiveWe aimed to investigate the association of recent team leader simulation training (<6 months) and years of clinical experience (≥4 years) with chest compression quality during in-hospital cardiac arrest (IHCA). MethodsThis cohort study of IHCA in four Danish hospitals included cases with data on chest compression quality and team leader characteristics. We assessed the impact of recent simulation training and experienced team leaders on longest chest compression pause duration (primary outcome), chest compression fraction (CCF), and chest compression rates within guideline recommendations using mixed effects models. ResultsOf 157 included resuscitation attempts, 45% had a team leader who recently participated in simulation training and 66% had an experienced team leader. The median team leader experience was 7 years [Q1; Q3: 4; 11]. The median duration of the longest chest compression pause was 16 s [10; 30]. Having a team leader with recent simulation training was associated with significantly shorter longest pause durations (difference: −7.11 s (95%-CI: −12.0; −2.2), p = 0.004), a higher CCF (difference: 3% (95%-CI: 2.0; 4.0%), p < 0.001) and with less guideline compliant chest compression rates (odds ratio: 0.4 (95%-CI: 0.19; 0.84), p = 0.02). Having an experienced team leader was not associated with longest pause duration (difference: −1.57 s (95%-CI: −5.34; 2.21), p = 0.42), CCF (difference: 0.7% (95%-CI: −0.3; 1.7), p = 0.17) or chest compression rates within guideline recommendations (odds ratio: 1.55 (95%-CI: 0.91; 2.66), p = 0.11). ConclusionRecent simulation training of team leaders, but not years of team leader experience, was associated with shorter chest compression pauses during IHCA.

Implementation of advanced vascular access, physiological monitoring and goal-directed resuscitation during OHCA in a helicopter emergency medical service.

Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest compression parameters and vasopressor administration to arterial diastolic blood pressure if invasive catheters are in situ at the time of cardiac arrest. However, prehospital initiation of arterial and central venous catheterisation is seldom undertaken due to the risks and significant technical challenges in the context of ongoing resuscitation in this environment. In 2019, a dedicated programme was started at East Anglian Air Ambulance (EAAA) to enable the safe introduction of contemporary emergency vascular access devices, in order to improve physiological monitoring intra-arrest and deliver nuanced, goal-directed resuscitation in OHCA patients. This programme was entitled Specialist Percutaneous Emergency Aortic Resuscitation (SPEAR). This article details the EAAA SPEAR technique; and the development, implementation and governance of this novel endovascular strategy in our UK physician-paramedic staffed helicopter emergency medical service.

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial.

Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS. This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

A computer-based examination of the quality of resuscitation measures based on device data

Sudden cardiac arrest represents a critical medical emergency where the quality of resuscitation measures is crucial for favorable outcomes[1,2]. The quality of cardiopulmonary resuscitation (CPR) can be assessed through the analysis of data recorded by the defibrillator during CPR. The data is routinely recorded at the base of the emergency medical vehicles at the University Hospital of Graz.&#x0D; To assess CPR quality, algorithms were implemented to identify chest compressions based on the chest impedance and ventilations using the capnography signals. With these algorithms, parameters for CPR quality can be determined. A dataset with 522 cases was used, of which 97 cases were automatically discarded as they contained no or no relevant impedance signals.&#x0D; The mean chest compression rate of the cases is 116.3 ± 9.1 compressions per minute, which is within the target range of 90 – 120. However, in 31% of cases, the rate was found to be too high. The proportion of minutes without an adequate mean chest compression rate was 29.2 ([6.2; 60.4]) %.&#x0D; The mean ventilation frequency of all cases with capnography signal (150 cases) was 13.5 ± 3.6 ventilations per minute and, therefore, within the target range of a maximum of 15 ventilations. However, in 34% of cases, the ventilation frequency was too high.&#x0D; This work shows that a systematic and automated evaluation of defibrillator recordings is suitable for assessing the quality of resuscitation measures. The determined parameters produced plausible results and are consistent with the results of preliminary studies at the Medical University of Graz, which were carried out manually on significantly smaller datasets.

Accuracy of Automatic Chest Compression Detection of Different Manufacturers

Research question The detection of single chest compressions (CCs) in defibrillator records is crucial to evaluate CPR quality parameters like longest pause duration.1 Currently, defibrillators detect CCs automatically and provide performance feedback via their proprietary software. While some manufacturers (e.g. Stryker) report the accuracy of their CC detection algorithm and allow to manually revise the automatically detected CCs to improve accuracy, others (e.g. ZOLL) do not offer this option.2 Recent works further suggest that using automatically detected CCs without revision or other open source methods is sufficient to compute quality markers.3,4 We aim to compare the accuracy of the automatic CC detection of two defibrillators. Methodology 131 defibrillator recordings from ZOLL’s X-Series devices with an applied feedback sensor and 70 recordings of Stryker’s LIFEPAK 15 devices were exported. ZOLL detects CC based on accelerometry data from its CC feedback sensor, while Stryker uses the thoracic impedance signal. Each set of recordings was annotated by a single annotator by adding missing CCs and deleting excess CCs, forming a ground truth. The results are reported as median, (10th percentile, 90th percentile) and were tested on statistical significance with a Mann-Whitney U test. Results Per case, the device by ZOLL detects in median 99.6, (97.8,99.9) % of all CCs correctly. 0.4, (0.1,2.3) % are deleted and 0.4, (0.1,2.3) % are added during the annotation process. For Stryker’s LIFEPAK 15 the respective numbers are: correctly detected: 96.7, (81.5,99.2) %, deleted: 1.8, (0.2,10.9) %, added: 3.3, (.8,18.5) %. The difference between the correctly identified CCs is significant (p&lt;0.0001). The distribution of missing and excess CCs for all cases is shown in Figure 1. Interpretation It appears that ZOLL’s CC detection via an accelerometry based feedback sensor is more accurate than Stryker’s method using thoracic impedance. However, Stryker’s accuracy exceeds 95% as well, providing a reasonably reliable basis for CPR quality marker calculations.

Metrics of impulsiveness of manual chest compressions for out-of-hospital cardiopulmonary resuscitation

AimPropose new metrics of impulsiveness of manual chest compressions (CCs) that account for shape and duration, separate the characteristics of the compressive part of the CC cycle from those of the recoil part, and are uncorrelated to CC depth and rate. MethodsWe conducted a retrospective analysis of adult out-of-hospital cardiac arrest monitor-defibrillator recordings having CPR data. Specifically, episodes of adult patients with ≥ 1000 compressions free of leaning were examined. CCs were obtained from the depth signal of the valid episodes, and we calculated the novel metrics: compression area index (CAI), recoil area index (RAI), compression impulsiveness index (CII) and recoil impulsiveness index (RII). Generalized linear mixed-effects models and Jonckheere-Terpstra trend analyses were employed to measure differences between populations and trends, and the absolute value of Pearson's correlation coefficient |r| was used to report dependence between variables. Statistics are reported as median and interquartile range. ResultsWe analyzed 982,340 CCs corresponding to 453 episodes, for which we calculated their CAI, RAI and duty cycle (DC). We analyzed the metrics for various populations: age, sex, any ROSC achieved and disposition, and found that CAI was significantly different according to patient disposition and RAI relative to age and sex (p<0.05). None of the metrics was correlated strongly to depth or rate (|r| values of 0.22 or smaller), and all of them varied for CC series corresponding to the same rescuer over the course of resuscitation (ptrend<0.05). However, we observed that the metrics are not balanced, in that for any value of DC, CAI and RAI span almost their entire ranges. ConclusionThe proposed metrics correctly and completely describe manual CC waveforms, improve upon the DC, since they depend on the signal waveform, and provide additional information to current indicators of quality CPR, depth and rate. Furthermore, they allow to differentiate the compressive and recoil parts of the CC cycle, reflecting influence of the rescuer (via CAI or CII) and of the biomechanics of the patient's chest (via RAI or RII). Thus, they have the potential to contribute to better understanding CPR dynamics and, eventually, to enhanced quality of CPR practice as additional indicators of proper manual CC technique.

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.

Nurses' motivation for performing cardiopulmonary resuscitation: a cross-sectional study.

Nurse motivation can have a significant impact on the quality of cardiopulmonary resuscitation and the patients' survival. Therefore, the present study aimed to examine nurses' motivation for performing cardiopulmonary resuscitation. This cross-sectional study focused on 217 nurses in a teaching hospital in Iran, in 2023. A random sample of nurses was selected from four hospital departments (emergency, critical care, medical, and surgery). These nurses completed the demographic information and motivation for cardiopulmonary resuscitation questionnaires. The data were analyzed using Mann-Whitney, Spearman coefficients, and Kruskal-Wallis and multiple linear regression tests. The mean score of the dimension of the feeling of achievement (4.10 ± 0.50) was high in the nurses' motivation for performing cardiopulmonary resuscitation. There were more motivational factors in the emergency department compared to the other departments in terms of the feeling of achievement, high chance of success, low chances of success, recognition and appreciation, perceived importance, and beliefs (p < 0.05). The nurses who had participated in cardiopulmonary resuscitation workshops and had a bachelor's degree had a higher mean score in the dimension of perceived importance (p < 0.05). The correlation coefficient showed that there was a significant negative correlation between the nurses' frequency of participation in cardiopulmonary resuscitation and their motivation scores in the dimensions of the feeling of achievement(r=-0.170), low chances of success(r=-0.183), perceived importance (r = -0.302), and beliefs (r = -0.250; p < 0.05). The department variable predicted the motivation score in the dimensions of feeling of achievement, high chance of success, low chance of success, perceived importance, and beliefs. The sex variable predicted the motivation score in the dimensions of facilitator of resuscitation and high chance of success. Besides, the variable of years of membership in the CPR team predicted the motivation score in the feeling of achievement and high chance of success (p < 0.05). Nurses would be more motivated to perform a quality cardiopulmonary resuscitation if they had a feeling of success. The nurses' motivation was affected by certain factors such as their department, sex, education level, years of membership in CPR team, number of participation in CPR, and participation in educational workshops.

Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest

ObjectiveWe sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge. MethodsWe completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA. ResultsThere were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052). ConclusionsThe COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.

Диспетчерское сопровождение оказания первой помощи очевидцами события при внегоспитальной остановке кровообращения у пострадавшего: реалии и перспективы

Summary. Purpose of the study. The purpose of this work is to analyze the practical experience of remote support of first aid in out-of-hospital circulatory arrest using the example of the State Budgetary Institution of Health “Emergency Station of the Gelendzhik Resort City” of the Ministry of Health of the Krasnodar Territory. Material and methods. The empirical basis of the scientific research was the analytical material on dispatching support for the provision of first aid in case of out-of-hospital circulatory arrest, contained in the works of Russian and foreign scientists. A study was made of the regulations governing the organization of first aid, including dispatching support for its provision. Research results and their analysis. The experience of the GBUZ “Emergency Station of the Resort City of Gelendzhik” of the Ministry of Health of the Krasnodar Territory showed that the effectiveness of cardiopulmonary resuscitation in cases of circulatory arrest before the arrival of an ambulance, when eyewitnesses provided first aid during dispatching support (the proportion of successful resuscitations – 8.6%), was similar to that in cases of circulatory arrest in the presence of emergency medical professionals (7.4%). In this regard, one of the options for increasing the frequency and quality of CPR by eyewitnesses of the incident may be to accompany the CPR by a telephone emergency dispatcher.

Contributions of mobile applications to pre-hospital care: integrative review

Objective: Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods: Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations &amp; Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords “Pre-Hospital Assistance”, “Pre-Hospital Care”, “Pre-Hospital Services”, “Pre-Hospital Emergency Care”, “Nursing”, “Mobile applications”, “Portable Software Applications”, and “Mobile Apps” in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results: From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions: The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study.

Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.

The effect of pocket mask training on the self-efficacy and willingness to perform artificial respiration in cardiac arrest patients: A randomized control trial

Background: Out-of-hospital cardiac arrest due to hypoxia, it is necessary to provide adequate oxygen for correction of the cause. So, the purpose of this study was to compare the overall quality of CPR, willingness to perform ventilation using ventilation aids, and self-efficacy compared to the enlisted ventilation method (MMV) by educating the general public on pocket masks (MPV), which are respiratory aids. Methods: This study was a randomized controlled comparative study, in which 110 study subjects were listed with numbered names in the order in which they applied for training, and random numbers were named A (MMV method) and B (MPV method) in that order. Randomization generated a random number order using the SAS program, and the generated random numbers A and B were arranged from 1 to 110 in the order in which they applied for training, through this, they were classified into A groups (N = 57) and B groups (N = 53). The study subjects classified into Group A received CPR training including enlistment ventilation on April 22, 2023, and the trainees in Group B received CPR training using a ventilator on April 29, 2023. Results: The primary outcome is that the result of the comparison of ventilation quality is the mean Tidal Volume (TV) before training for MPV is 1076 ± 422, whereas the mean TV for MMV is 1015 ± 510 (p &lt; 0.05). After training, the mean tidal volume (TV) for MPV is 876ml ± 422, whereas the mean TV for MMV is 1001 ± 516, indicating that MMV resulted in a significantly higher tidal volume than the ILCO guidelines. After training, comparing the time per ventilation cycle, the MPV group showed 0.923sec ± 0.432, while the MMV group showed 1.021sec ± 0.535 (p &lt; 0.05). After completing two ventilations, it is evident that there is a delay in starting the next chest compression in the MMV group compared to the MPV group (MMV: 10.21 ± 4.112 vs. MPV: 9.88 ± 2.831, p &lt; 0.05). Conclusion: As a result of this study, the researcher recommends adding training on pocket masks when educating artificial respiration in CPR training conducted in Korea, given that the performance accuracy of pocket masks is high and the efficient ventilation rate is high.

Effectiveness of Feedback with Mobile Devices for Quality Measure of CPR Training: A Systematic Review

Cardiopulmonary resuscitation (CPR) is a life-saving skill that can significantly increase survival rates in an emergency. Medical professionals, health students, and trained lay people must all perform high-quality CPR. As an outcome, effective CPR training using instruments that support the achievement of high-quality CPR is essential. Objective: This systematic review aimed to evaluate the effectiveness of feedback provided via mobile devices in measuring the quality of CPR training. Method: Design used systematic review with reference to the PRISMA Statement Guidelines 2020. Search results through database of ScienceDirect (778 articles), Wiley Online Library (765 articles), PubMed (55 articles), and ResearchGate (73 articles). The research designs of articles analyzed was randomized controlled trial which published from 2013 to 2023 with the keywords cardiopulmonary resuscitation, CPR training, mobile devices. The sample in this study was taken from five articles that match the inclusion criteria. JBI's critical assessment tool for assessing bias risk in randomly controlled 2023 checklist tests is used to critically evaluate the instruments used for the selected article. Results: The primary results that five publications were based on CPR quality metrics such as chest compression depth and speed, as well as the proportion of acceptable chest compression depth. Conclusions: This review discovered evidence that mobile devices have an effect on the effectiveness of real-time feedback on CPR quality in CPR training. CPR trainees received effective instant guidance from a variety of mobile devices, including smartphones and smart watches equipped with sensors.

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

PENGETAHUAN PERAWAT MEMBERIKAN HIGH QUALITY CPR DAN KESIAPSIAGAAN DALAM MANAJEMEN BENCANA DI INSATALASI GAWAT DARURAT DI 4 RUMAH SAKIT DAERAH DI KAB. SEMARANG

Blockage of coronary arteries causes problems in the heart's electrical system, one of them is cardiac arrest occurs suddenly at any time and at anyone. The heart failure caused the supply of food to organs to decrease. As health workers, knowledge of High-QualityPR must be maintained by nurses in dealing with cardiac arrest, and as part of preparedness, nurses carry out their duties when disaster occurs. Objective: This research aims to determine nurses' knowledge of improving High-Quality CPR capabilities in practice settings and in disaster activities. Research method: this research used qualitative descriptive design using the Convenience Sampling Technique, namely sampling taken based on the wishes of the researcher based on convenience, adequacy, and cooperation. Research solution: nurses in carrying out their duties in health services and disaster preparedness must know High-Quality CPR and carry out activities to reduce disasters in patients who experience cardiac arrest problems. Conclusion: This research is expected to confirm in provision High Quality CPR services. Keywords: Cardiac Arrest, High-Quality CPR, Knowledge

CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial

BackgroundAn out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. MethodsThis multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. ResultsIn total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57–70.98) and the second attempt (48.68, 95% CI 31.31–66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54–227.37) compared with the second attempt (136.95, 95% CI 87.03–186.88, p = 0.1). ConclusionA dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.