Quality Of Resuscitation Research Articles

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study

BackgroundAlthough airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.MethodsIn this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.ResultsA total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).ConclusionsCOVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program improves chest compression rate in real world out-of hospital cardiac arrest patients

BackgroundThe Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program is designed to enhance cardiopulmonary resuscitation (CPR) training by using real-time feedback manikins. Our objective was to assess the quality of CPR, such as chest compression rate, depth, and fraction, performed on out-of-hospital cardiac arrest (OHCA) patients among paramedics trained with the RQI® program vs. paramedics who were not. Methods and ResultsAdult OHCA cases from 2021 were analyzed; 353 OHCA cases were classified into one of three groups: 1) 0 RQI®-trained paramedics, 2) 1 RQI®-trained paramedic, and 3) 2–3 RQI®-trained paramedics. We reported the median of the average compression rate, depth, and fraction, as well as percent of compressions that were between 100 to 120/minute and percent of compressions that were 2.0 to 2.4 inches deep. Kruskal-Wallis Tests were used to assess differences in these metrics across the three groups of paramedics. Of 353 cases, the median of the average compression rate/minute among crews with 0, 1, and 2–3 RQI®-trained paramedics was 130, 125, and 125, respectively (p = 0.0032). Median percent of compressions between 100 to 120 compressions/minute was 10.3%, 19.7%, and 20.1% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.0010). Median of the average compression depth was 1.7 inches across all three groups (p = 0.4881). Median compression fraction was 86.4%, 84.6%, and 85.5% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.6371). ConclusionsRQI® training was associated with statistically significant improvement in chest compression rate, but not improved chest compression depth or fraction in OHCA.

Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest.

To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). Retrospective cohort study. An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. None. We analyzed 418 shocks delivered during 159 cardiac arrest events, with 381 shocks during 158 events at 28 sites remaining after excluding undecipherable rhythms. We classified shocks as: 1) appropriate (ventricular fibrillation [VF] or wide complex ≥ 150/min); 2) indeterminate (narrow complex ≥ 150/min or wide complex 100-149/min); or 3) inappropriate (asystole, sinus, narrow complex < 150/min, or wide complex < 100/min) based on the rhythm immediately preceding shock delivery. Of delivered shocks, 57% were delivered appropriately for VF or wide complex rhythms with a rate greater than or equal to 150/min. Thirteen percent were classified as indeterminate. Thirty percent were delivered inappropriately for asystole (6.8%), sinus (3.1%), narrow complex less than 150/min (11%), or wide complex less than 100/min (8.9%) rhythms. Eighty-eight percent of all shocks were delivered in ICUs or emergency departments, and 30% of those were delivered inappropriately. The rate of inappropriate shock delivery for pediatric IHCA in this international cohort is at least 30%, with 23% delivered to an organized electrical rhythm, identifying opportunity for improvement in rhythm identification training.

Clinician-reported physiologic monitoring of cardiopulmonary resuscitation quality during pediatric in-hospital cardiac arrest: A propensity-weighted cohort study

AimsThe primary objective was to determine the association between clinician-reported use of end-tidal CO2 (ETCO2) or diastolic blood pressure (DBP) to monitor cardiopulmonary resuscitation (CPR) quality during pediatric in-hospital cardiac arrest (pIHCA) and survival outcomes. DesignA retrospective cohort study was performed in two cohorts: (1) Patients with an invasive airway in place at the time of arrest to evaluate ETCO2 use, and (2) patients with an arterial line in place at the time of arrest to evaluate DBP use. The primary exposure was clinician-reported use of ETCO2 or DBP. The primary outcome was return of spontaneous circulation (ROSC). Propensity-weighted logistic regression evaluated the association between monitoring and outcomes. SettingHospitals reporting to the American Heart Association’s Get With The Guidelines®– Resuscitation registry (2007–2021). PatientsChildren with index IHCA with an invasive airway or arterial line at the time of arrest. ResultsBetween January 2007 and May 2021, there were 15,280 pediatric CPR events with an invasive airway or arterial line in place at the time of arrest. Of 7159 events with an invasive airway, 6829 were eligible for analysis. Of 2978 events with an arterial line, 2886 were eligible. Clinicians reported using ETCO2 in 1335/6829 (20%) arrests and DBP in 1041/2886 (36%). Neither exposure was associated with ROSC. ETCO2 monitoring was associated with higher odds of 24-hour survival (aOR 1.17 [1.02, 1.35], p = 0.03). ConclusionsNeither clinician-reported ETCO2 monitoring nor DBP monitoring during pIHCA were associated with ROSC. Monitoring of ETCO2 was associated with 24-hour survival.

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Use of Perfusion Index to Monitor Quality of Cardiopulmonary Resuscitation

Effect of other venous access on cardiopulmonary resuscitation quality: A prospective, randomized, controlled trial

ABSTRACT This randomized controlled study aimed to prospectively evaluate the application effects of other venous access in patients undergoing cardiopulmonary resuscitation. A total of 212 patients who underwent respiratory and cardiac arrest were randomly divided into peripheral intravenous (IV) access group (IV group, n = 69), femoral vein catheterization group (FVC group, n = 72), and internal jugular vein catheterization group (IJVC group, n = 71). The puncture time, first administration time, pressure interruption time caused by the establishment of fluid pathway, endotracheal intubation time, complications, ROSC time, and ETCO2 were recorded. The time of establishing venous access was: IV<FVC<IJVC. The once puncture success rate of the FVC group was markedly higher than that in IV and IJVC groups (P < 0.01). There was no significant difference in ROSC time between the FVC, IV, and the IJVC group (P = 0.23). The ROSC time in the FVC group was higher than in the IV and IJVC groups (P < 0.01). The success rate of ROSC in the FVC group and IJVC group were better than that in the IV group (PVC>IJVC>IV, P = 0.04). There was no significant difference in EtCO2 between the FVC, IV group, and IJVC group (PVC>IJVC>IV, P = 0.17). Due to catheterization, the time of suspending chest compression in the FVC group was significantly lower than in the IJVC group (5s vs. 12s). The time of establishing an artificial airway in the IV (38s) and FVC (35s) group were significantly longer than that in IJVC (52s) group. Central venous catheterization is more effective than peripheral venous catheterization in cardiopulmonary resuscitation. Moreover, femoral vein access was more effective than internal jugular vein access.

Predicting Cardiac Arrest in Children with Heart Disease: A Novel Machine Learning Algorithm

Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has not improved. Cardiac arrest prevention, using predictive algorithms with machine learning, has the potential to reduce cardiac arrest rates. However, few studies have evaluated the use of these algorithms in predicting cardiac arrest in children with heart disease. We collected demographic, laboratory, and vital sign information from the electronic health records (EHR) of all the patients that were admitted to a single-center pediatric cardiac intensive care unit (CICU), between 2010 and 2019, who had a cardiac arrest during their CICU admission, as well as a comparator group of randomly selected non-cardiac-arrest controls. We compared traditional logistic regression modeling against a novel adaptation of a machine learning algorithm (functional gradient boosting), using time series data to predict the risk of cardiac arrest. A total of 160 unique cardiac arrest events were matched to non-cardiac-arrest time periods. Using 11 different variables (vital signs and laboratory values) from the EHR, our algorithm's peak performance for the prediction of cardiac arrest was at one hour prior to the cardiac arrest (AUROC of 0.85 [0.79,0.90]), a performance that was similar to our previously published multivariable logistic regression model. Our novel machine learning predictive algorithm, which was developed using retrospective data that were collected from the EHR and predicted cardiac arrest in the children that were admitted to a single-center pediatric cardiac intensive care unit, demonstrated a performance that was similar to that of a traditional logistic regression model. While these results are encouraging, future research, including prospective validations with multicenter data, is warranted prior to the implementation of this algorithm as a real-time clinical decision support tool.

Impact of trauma teams on high grade liver injury care: a two-decade propensity score approach study in Taiwan

High-grade liver laceration is a common injury with bleeding as the main cause of death. Timely resuscitation and hemostasis are keys to the successful management. The impact of in-hospital trauma system on the quality of resuscitation and management in patients with traumatic high-grade liver laceration, however, was rarely reported. We retrospectively reviewed the impact of team-based approach on the quality and outcomes of high-grade traumatic liver laceration in our hospital. Patients with traumatic liver laceration between 2002 and 2020 were enrolled in this retrospective study. Inverse probability of treatment weighting (IPTW)-adjusted analysis using the propensity score were performed. Outcomes before the trauma team establishment (PTTE) and after the trauma team establishment (TTE) were compared. A total of 270 patients with liver trauma were included. After IPTW adjustment, interval between emergency department arrival and managements was shortened in the TTE group with a median of 11 min (p < 0.001) and 28 min (p < 0.001) in blood test reports and duration to CT scan, respectively. Duration to hemostatic treatments in the TTE group was also shorter by a median of 94 min in patients receiving embolization (p = 0.012) and 50 min in those undergoing surgery (p = 0.021). The TTE group had longer ICU-free days to day 28 (0.0 vs. 19.0 days, p = 0.010). In our study, trauma team approach had a survival benefit for traumatic high-grade liver injury patients with 65% reduction of risk of death within 72 h (Odds ratio (OR) = 0.35, 95% CI = 0.14–0.86) and 55% reduction of risk of in-hospital mortality (OR = 0.45, 95% CI = 0.23–0.87). A team-based approach might contribute to the survival benefit in patients with traumatic high-grade liver laceration by facilitating patient transfer from outside the hospital, through the diagnostic examination, and to the definitive hemostatic procedures.

Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms.

Studies have shown that standardized code teams may improve outcomes following cardiac arrests. Pediatric intra-operative cardiac arrests are rare events and are associated with a mortality rate of 18%. There is limited data available regarding use Medical Emergency Team (MET) response to pediatric intra-operative cardiac arrest. The purpose of this study was to identify the use of MET in response to pediatric intraoperative cardiac arrest as an exploratory step in establishing evidence-based standardized practice across the hospital for training and management of this rare event. An anonymous electronic survey was created and sent to two populations: The Pediatric Anesthesia Leadership Council, a section of the Society for Pediatric Anesthesia, and the Pediatric Resuscitation Quality Collaborative, a multinational collaborative group, which works to improve resuscitation care in children. Standard summary and descriptive statistics were used for survey responses. The overall response rate was 41%. The majority of respondents worked in a university affiliated, free-standing children's hospital. Ninety-five percent of respondents had a dedicated pediatric MET at their hospital. In 60% of responses from Pediatric Resuscitation Quality Collaborative and 18% of Pediatric Anesthesia Leadership Council hospitals, the MET responds to pediatric intra-operative cardiac arrest; however, the majority of times MET involvement is requested rather than automatic. The MET was found to be activated intraoperatively for situations other than cardiac arrest such as, massive transfusion events, need for extra staff, and for specialty expertise. In 65% of institutions, simulation-based training for cardiac arrest is supported but lacking pediatric intra-operative focus. This survey revealed heterogeneity in the composition and response of the medical response teams responding to pediatric intra-operative cardiac arrests. Improved collaboration and cross training among MET, anesthesia, and operating room nursing may improve outcomes of pediatric intra-operative code events.

CPR quality with rotation of every 1 versus 2 minutes as characteristics of rescuers: A randomized crossover simulation study.

Fatigue and rotation time are key factors affecting the quality of cardiopulmonary resuscitation (CPR). This study aimed to investigate the effects of rotation time on CPR duration, and sex on chest compression quality. In this randomized crossover simulation study, we enrolled 100 paramedic students stratified by sex and randomly grouped into 28 male and 22 female pairs. In the 2- and 1-minute scenarios, 2 participants performed CPR for 20 minutes with a rotation cycle of 2 minutes and 1 minute, respectively. After taking a break, they changed over and performed CPR again for 20 minutes. The switching of roles was performed with the students positioned on opposite sides of the mannequin. For chest compression quality, a set was defined as CPR performed by 1 pair in a 2-minute scenario for 4 minutes. The quality of CPR in each set was compared between the 2 groups. The 1-minute group showed significantly higher chest compression depth than the 2-minute group (54.0 [51.5-57.0] vs 52.5 [48.5-56.5] mm, P = .001, respectively). The female 2-minute group showed decreased chest compression depth over time, and the 1-minute group showed significantly increased chest compression depth during all sets except the 2nd set (54.0 [51.9-55.1] vs 50.5 [48.5-53.8] mm [P = .030], 52.3 [49.4-54.5] vs 50.8 [47.0-53.1] mm [P = .080], 52.8 [49.8-54.5] vs 48.8 [45.4-51.6] mm [P = .002], 51.5 [48.5-53.3] vs 48.3 [44.5-50.6] mm [P = .004], and 50.8 [48.9-54.1] vs 47.5 [44.6-50.1] mm [P = .001], respectively). The fatigue scores in the 2-minute group were significantly higher during sets 4 and 5 than those in the 1-minute group. When rescuer fatigue increases during prolonged CPR owing to their physical strength and skill levels, the rotation of rescuers every minute would be helpful in maintaining high-quality CPR.

Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines during In-Hospital Cardiac Arrest in Children.

Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children. We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO2 (EtCO2), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate. We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (p=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (p=0.016) and 100% vs. 63% (p=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (p=0.014). Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.

Descriptive statistics and risk factor analysis of children with community-acquired septic shock

BackgroundChildren with community-acquired septic shock can rapidly deteriorate and die in acute-care hospitals. This study aimed to describe the mortality, timing, and risk factors in children with community-acquired septic shock.MethodsThis is a retrospective cohort study using a national inpatient database in Japan. The study population included children (age < 20 years) who were admitted to acute-care hospitals with a diagnosis of sepsis from July 2010 to March 2020, who were treated with antibiotics, and who were supported with vasoactive drugs within three days of hospitalization. We used a Cox proportional-hazards regression model to identify risk factors for earlier death.ResultsAmong 761 eligible children, the median age was 3 (interquartile range, 0–11) years and 57.2% had underlying conditions. Among these, 67.1% were admitted to accredited intensive care units within three days of hospitalization and 38.6% were transported from other hospitals. The median hospital volume, defined as the number of eligible children in each hospital over the study period, was 4 (interquartile range, 2–11). Overall, 244 children died (in-hospital mortality rate, 32.1%). Among them, 77 (31.6%) died on the first day, and 156 (63.9%) died within three days of hospitalization. A Cox proportional-hazards regression model showed that earlier death was associated with lower hospital volume and age 1–5 years, whereas it was inversely associated with admission to an accredited intensive care unit and transport from other hospitals. Among 517 survivors, 178 (34.4%) were discharged with comorbidities.ConclusionsChildren with community-acquired septic shock had high mortality, and early death was common. Our findings may warrant future efforts to enhance the quality of initial resuscitation for sepsis in low-volume hospitals and to ensure a healthcare system in which children with sepsis can be treated in accredited intensive care units.

Comparison of the CPR Feedback Device Effect on the Effective Technique of the CPR in Two Modes of the Device Warning Being On and Off.

Out-of-hospital cardiac arrest is a major public health problem with over 90% case fatality. Although it is known that good quality of cardiopulmonary Resuscitation (CPR) leads to improved patient outcomes, health care practitioners commonly perform sub-optimal CPR. The CPR feedback device is a small device designed to measure the number and depth of chest compressions (CC) and if the rate of compressions or the depth of the compressions is low or high, it will try to correct the CPR operation by announcing a warning to the resuscitator. The aim of this study was to evaluate the effectiveness of this device which was designed and made by the authors' technician study group member in improving CPR operations, to determine the need for it in all hospitals on a routine basis. This cross-sectional study was performed on patients who have suffered from cardio-pulmonary arrest in Al-Zahra Hospital in 2020. Patients needed primary CPR for any reason, were randomly divided into two groups using random allocation software. The first group contains patients as the CPR Feedback device is on and alarm is on and warns, if resuscitation is ineffective, the second group also uses the device, but with the difference that the alarm is off. The data was analyzed by general linear model method (repeated measure ANOVA). 80 patients were studied, including 63 men (79%) and 17 women (21%). Patients were divided among two groups. There was no significant difference in demographic characteristics between two groups. The results showed that there was no significant interaction between group and time for the compression depth variable and there was no significant difference in the depth of compressions between the two groups(P>0.05). For the rate of compressions, there was a significant interaction between group and time. These results indicate that turning on the CPR feedback device's warning increases the number of compressions during CPR and, as a result, makes it more effective. The between-group effect which showed the difference in the number of compressions in the two groups, was statistically significant (P<0.001). These results indicated that turning on the CPR feedback device's warning increases the rate of compressions during CPR and, as a result, makes it more effective. Therefore, the use of real-time CPR feedback device during chest compression in real-time CPR improves the quality of CPR.

Innovative Cardiopulmonary Resuscitation Instruction: One School of Nursing's Experience Piloting the NLN, Laerdal, and American Heart Association Resuscitation Quality Improvement Program.

Innovative Cardiopulmonary Resuscitation Instruction: One School of Nursing's Experience Piloting the NLN, Laerdal, and American Heart Association Resuscitation Quality Improvement Program.

Comparison of cardiopulmonary resuscitation quality performed by a single rescue with a bag-valve mask device: Over-the-head or lateral position?

IntroductionThe highest quality and effectiveness of Cardiopulmonary Resuscitation (CPR) will be difficult to achieve if ventilatory assistance is provided using a Bag-Valve Mask (BVM) device and combined with compression by a single rescue. This study aims to compare the different qualities of CPR between the over-the-head (OTH) position and the lateral position performed by a single rescue with a BVM device. MethodThis study was a comparative study, comparing the quality of CPR produced by lateral position and OTH position on mannequins. This study involved 100 respondents divided into two groups, namely 50 respondents had lateral position and 50 had OTH position. CPR quality assessment was guided by five CPR quality indicators referring to the American Heart Association (AHA). The statistical test used was Mann-Whitney. ResultsStatistical tests show CPR using the OTH position had higher quality than the lateral position (p = 0.004). Based on five CPR quality indicators, two indicators had a significant difference between the OTH and lateral positions, namely speed (p = 0.026), and interruption (p = 0.008). Meanwhile, the other three indicators did not have significant differences, namely depth (p = 0.427), hand placement (p = 1.000), and complete chest recoil (p = 1.185). ConclusionThe OTH position was more effective and had better quality when CPR used a single rescue with a BVM device compared to the lateral position.

Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021

The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021. To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology &amp; Public Health; Prehospital Resuscitation; In-Hospital Resuscitation &amp; Post-Arrest Care; Prognostication &amp; Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication. Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively. Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation.

Segítség a távolból – A videoasszisztált újraélesztés jelene és jövője

Quick and high-quality cardiopulmonary resuscitation has an important role in the survival of out-of-hospital cardiac arrest. In the majority of the cases, the victim is detected by a layperson. Usually, the ratio of giving help is lower than expected. Dispatcher-assisted cardiopulmonary resuscitation can improve the helping attitude and the quality of cardiopulmonary resuscitation by giving instructions during the emergency call. Telephone-assisted cardiopulmonary resuscitation is widely available worldwide. In addition, video-assisted cardiopulmonary resuscitation provides the possibility of not only voice-based but also video-based communication. This can provide real-time feedback from the scene, the victim and the bystander. Previous simulation studies showed the advantages of video-assisted cardiopulmonary resuscitation. The technology is available in some countries in the real-life health care system. Despite positive effects, we need to examine also less studied aspects which can influence the effectiveness of the technology such as camera position, quality of the video, environmental factors, and the knowledge and attitude of dispatchers and bystanders related to video-assisted cardiopulmonary resuscitation. Clarifying these factors is important because the availability of technology in itself is not a guarantee of successful implementation. In conclusion, the establishment of a national CPR register is suggested. The introduction of the V-CPR method requires studies conducted in a domestic environment. It is recommended to form a professional consensus working group, involving all relevant experts to develop V-CPR guidelines. Orv Hetil. 2023; 164(1): 11-18.

The association of chest compressor&amp;apos;s physical activity level with the quality of continuous chest compressions during a stimulated cardiac arrest in an education center

Background: Cardiopulmonary resuscitation (CPR) is a lifesaving procedure performed by qualified rescuers. The quality of CPR depends on effective chest compression (CC) characteristics: rate, depth, hand position, and chest recoil. Besides CC, previous research has proven that physical activity level (PAL) varies among rescuers and affects CPR quality. This study aims to assess the association between PAL and the quality of continuous chest compressions-cardiopulmonary resuscitation (CCC-CPR) for 5 minutes by qualified rescuers at the National Guard Hospital in Jeddah (NGHA-J). Methods: This is a cross-sectional study. The global physical activity questionnaire was used to measure the participants&amp;apos; PALs, and the SimMan 3G mannequin was used to measure the four CC characteristics. The recommended sample size is 45 of the rescuers at NGHA-J. Results: A total of 45 members were involved in the study, and most participants were 27 (60%) males. Most participants are classified as having high PAL 21(46.67%). The study indicates that there is no significant effect among the PALs and the CCC-CPR effectiveness according to (p 0.65) which is determined by the non-parametric Kruskal Wallis test. The optimal effective CCs between the three groups of PALs were achieved by the moderate PAL participants with a median of 47.5 (IQR 35). Conclusion: The study findings deny any relationship between the quality of the CCC-CPR and the PAL of the rescuers.