Cardiopulmonary Resuscitation Rates Research Articles

First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods

Introduction First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. Methods We linked the 2014–2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. Results We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22–0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65–0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61–0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17–0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10–0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. Conclusion While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.

Relationship of Public Interest in Cardiopulmonary Resuscitation with Cardiac Arrest Epidemiology and National Socioeconomic Indicators: Exploratory Infodemiology Study.

Web-based big data analytics provides a great opportunity to measure public interest in cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). This study aimed to examine associations of online interest in CPR and CA with epidemiological characteristics of out-of-hospital CA (OHCA) and national socioeconomic indicators in a set of European countries. Country-level online search popularity data for CPR and CA topics measured in relative search volume (RSV) with Google Trends (GT), published OHCA epidemiological indicators, and World Bank's socioeconomic statistics of 28 European countries for the year 2017 were analyzed for correlation using Spearman's rank correlation coefficient (r S ). Whereas OHCA incidence, bystander CPR rate, and hospital survival did not correlate with RSV for CPR or CA, the rate of return of spontaneous circulation (ROSC) demonstrated a positive correlation with RSV for CPR (r S = 0.388; P = .042). Further, RSV for CPR positively correlated with countries' gross domestic product and health expenditure (r S = 0.939 and 0.566; P ≤.002) and negatively correlated with mortality caused by road traffic injury (r S = -0.412; P = .029). For the sample of European countries, public interest in CPR or CA showed no relationship with real bystander CPR rates and therefore could not be recommended as a proxy of community readiness to attempt resuscitation. The association of RSV for CPR with the rate of ROSC and countries' socioeconomic characteristics suggests it could be used for identifying geographies with poor performance of prehospital systems in terms of managing CA, in particular where effective epidemiological surveillance for CA may be unavailable.

Effects of the 2020 COVID-19 pandemic on outcomes of out-of-hospital cardiac arrest and bystander resuscitation efforts: a nationwide cohort study in Japan.

Background and importance There is limited knowledge about the nationwide impact of the 2020 COVID-19 pandemic in Japan on out-of -hospital cardiac arrest (OHCA) outcomes.Objectives The aim of this study was to investigate the impact of the 2020 COVID-19 pandemic on OHCA outcomes and bystander resuscitation efforts in Japan. Design Retrospective analysis of a nationwide population-based registry of OHCA cases. Settings and participants To conduct this study, we created a comprehensive database comprising 821 665 OHCA cases by combining and reconciling the OHCA database for 835 197 OHCA cases between 2017 and 2020 with another database, including location and time records. After applying exclusion and inclusion criteria, we analysed 751 617 cases.Outcome measures and analysis The primary outcome measure for this study was survival with neurologically favourable outcome (cerebral performance category 1 or 2). We compare OHCA characteristics and outcomes between prepandemic and pandemic years, and also investigated differences in factors associated with outcomes. Results We found that survival with neurologically favourable outcome and the rates of bystander cardiopulmonary resuscitation (CPR) slightly increased in the pandemic year [2.8% vs. 2.9%; crude odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.10; 54.1% vs. 55.3%, 1.05 (1.04-1.06), respectively], although the incidence of public access defibrillation (PAD) slightly decreased [1.8% vs. 1.6%, 0.89 (0.86-0.93)]. Calls for hospital selection by emergency medical service (EMS) increased during the pandemic. Subgroup analysis showed that the incidence of neurologically favourable outcome increased in 2020 for OHCA cases that occurred on nonstate of emergency days, in unaffected prefectures, with noncardiac cause, nonshockable initial rhythm, and during daytime hours. Conclusions During the 2020 COVID-19 pandemic in Japan, survival with neurologically favourable outcome of OHCA patients and bystander CPR rate did not negatively change, despite the decrement in PAD incidence. However, these effects varied with the state of emergency, region, and characteristics of OHCA, suggesting an imbalance between medical demand and supply, and raising concerns about the pandemic.

The dramatic increase in sudden cardiac deaths and the alarming low survival: A global call to action to improve outcome with the engagement of tertiary education system.

The number of out-of-hospital cardiac arrests, cause of disability and death, has dramatically increased worldwide, but despite the progress, the incidence of survival does not appear to have increased significantly. Bystander cardiopulmonary resuscitation (CPR) remains the principal factor in saving out-of-hospital cardiac arrest victims. Analyzing the immense efforts produced by states and professional organizations to train people in CPR skills for immediate intervention in the occurrence of a cardiac arrest, the primary global strategy is centered on CPR education and training for schoolchildren. But the rate of CPR training remains low, with wide differences among communities. The concept of CPR training for schoolchildren to increase bystander CPR rates needs to be implemented. We suggest a global call to action for the tertiary education system for CPR learning and training, including all undergraduate students regardless of the degree course, as a possible method to improve the traditional CPR training today centered on the secondary education system. Extending CPR training courses to the university educational system could significantly increase the number of people educated in life-saving maneuvers. The final objective is to improve the survival rate of patients with out-of-hospital primary cardiac arrest, which has dramatically increased worldwide.

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situations and requires strict implementation of cardiopulmonary resuscitation (CPR) protocols. Since ultrasound is one of the recommended tools to determine the presence of cardiac movements and may be a predictor of the outcome, this study examined the relationship between echocardiographic findings during CPR with patients’ outcomes. Methods: This cross-sectional prospective observational study was conducted on patients with cardio-respiratory arrest in the emergency department of Shariaty hospital during 2019. sampling method was random. Echocardiography was done at the patient’s bedside during the CPR process in accordance with the last advanced cardiac life support (ACLS) guidelines, on two points, after the end of the second and 10th minutes from the start of CPR. The echocardiography findings (cardiac movement vs standstill) were recorded, and patient outcomes were followed. Thirty-two patients enrolled in this study with a mean age of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate the association between heart contractions during resuscitation and the outcomes via SPSS V.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationship between heart rhythm in the second and tenth minutes with the outcomes of CPR. Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to the findings of the second minute, had a significant correlation with the success rate of CPR and outcomes (P<0.05). Moreover, patients with ventricular tachycardia (VT)/ventricular fibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, and better outcome than patients with other cardiac rhythms and asystole (P<0.05). Conclusion: Echocardiographic findings in the 10th minute of the CPR process can be used as a prognostic factor for cardiac arrest.

Tele-Rapid Response Team (Tele-RRT): The effect of implementing patient safety network system on outcomes of medical patients-A before and after cohort study.

Rapid Response Teams were developed to provide interventions for deteriorating patients. Their activation depends on timely detection of deterioration. Automated calculation of warning scores may lead to early recognition, and improvement of RRT effectiveness. This was a "Before" and "After" study, in the "Before" period ward nurses activated RRT after manually recording vital signs and calculating warning scores. In the "After" period, vital signs and warning calculations were automatically relayed to RRT through a wireless monitoring network. When compared to the before group, the after group had significantly lower incidence and rate of cardiopulmonary resuscitation (CPR) (2.3 / 1000 inpatient days versus 3.8 / 1000 inpatient days respectively, p = 0.01), significantly shorter length of hospital stay and lower hospital mortality, but significantly higher number of RRT activations. In multivariable logistic regression model, being in the "After" group decreases odds of CPR by 33% (OR = 0.67 [95% CI: 0.46-0.99]; p = 0.04). There was no difference between groups in ICU admission. Automated activation of the RRT significantly reduced CPR events and rates, improved CPR success rate, reduced hospital length of stay and mortality, but increased the number of RRT activations. There were no differences in unplanned ICU admission or readmission.

Abstract 267: Differences Of Temporal Trends In Outcomes After Out-of-hospital Cardiac Arrest Between Urban And Rural Regions In Japan: A 4-year Observational Study From 2016 To 2019

Introduction: Recently, multiple studies have demonstrated improvement in survival after out-of-hospital cardiac arrest (OHCA). However, outcomes after OHCA vary with region and city worldwide. Hypothesis: Differences of temporal trends in outcomes after OHCA between rural and urban regions in Japan were postulated. Methods: We included 98,496 patients (aged ≥18 years) using an All-Japan Utstein-style Registry who were witnessed by bystanders after OHCA of presumed cardiac origin between January 1, 2016 and December 31, 2019. Based on population density, patients were classified into urban (n=76,411, 28 prefectures with a population of ≥200 inhabitants/km 2 ) and rural (n=22,085, 19 prefectures with a population of <200 inhabitants/km 2 ) groups. The study endpoints were 1-month survival and neurologically intact survival, defined with a cerebral performance category (CPC) score of 1 or 2. Results: The mean age in rural regions significantly increased from 77.1 years to 77.8 years ( P <0.01) despite unchanged patients’ age in urban regions for 4 years ( P =0.45). The bystander cardiopulmonary resuscitation (B-CPR) rate in urban regions significantly increased from 54.0% to 55.7% ( P <0.01) unlike in rural regions ( P =0.45). The overall crude 1-month survival and CPC 1-2 rates during the study periods were 10.9% and 6.8%, respectively. The overall 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.04 [95% confidence interval (CI), 1.02-1.07, P <0.01] and 1.03 [1.01-1.06, P <0.05]. In the urban group, 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.05 [95% CI, 1.03-1.08, P <0.01] and 1.04 [1.01-1.07, P <0.01]. However, in the rural group, 1-month outcomes did not significantly improve from 2016 to 2019; the corresponding risk-adjusted ratios per year were 0.99 [95% CI, 0.95-1.04, P =0.68] and 1.01 [0.95-1.07, P =0.74]. Conclusions: One-month outcomes after OHCA significantly improved over the recent 4 years in urban regions, unlike in rural regions in Japan. No change in B-CPR rate in rural regions was noted, and an increase in the B-CPR rate in urban regions may be associated with these results.

Abstract 143: Does Bystander Gender Make Difference In Outcomes Of Out Of Hospital Cardiac Arrest?

Objective: We hypothesize that there is difference in outcomes of out-of-hospital cardiac arrest according to bystander gender. Methods: We used a nationwide, out-of-hospital cardiac arrest cohort database during 2006-2020. We extracted cases involving patient older than 18 years with presumed cardiac etiology and witnessed arrest, but not by EMS or nursing home worker or medical personnel. The primary outcome was the good neurologic outcome. Secondary outcomes were successful bystander cardiopulmonary resuscitation rate which defined that starting bystander CPR and keep going until by EMS arrival and survival outcome. Results: The total number of populations was 24919 patients. Of these, 10413 patients (41.8%) were resuscitated by female bystander. When cardiopulmonary resuscitation by female bystander, patient more likely to achieve good neurological outcome (206(2.0%) vs 235(1.6%), p=0.344), and survival (352(3.4%) vs 400(2.8%), p=0.0046). However, female bystander less likely to do successful cardiopulmonary resuscitation (5730(55.0%) vs 9405(64.8%), p<0.0001). Adjusted odds ratios for good neurologic outcomes, survival and successful bystander cardiopulmonary resuscitation rate resuscitated by female bystander, when compared with male bystander, were 1.46 (1.18-1.80), 1.44 (1.23-1.69) and 0.68 (0.64-0.71), respectively. In the interaction model, adjusted odd ratio (95% Confidence interval) for good neurological outcome of patient resuscitated by female bystander was 1.53 (1.21-1.94) in patients who arrested at private place and 1.18 (0.71-1.98) in patients who arrested in public place. Conclusion: Patient who resuscitated by female bystander were more likely to have good neurologic outcome and achieve survival discharge. Effect of bystander gender was increased when patient arrested in private place.

Effectiveness of a novel augmented reality cardiopulmonary resuscitation self-training environment for laypeople in China: a randomized controlled trial

Abstract Objectives: The training rate of cardiopulmonary resuscitation (CPR) among the general population in China is relatively low. Augmented reality (AR) may be an effective method of CPR training, especially where in-person interactions may not be possible. The purpose of this study was to analyze the effectiveness of AR CPR self-training for people who are not professional health care workers. Methods: A 2-arm and prospective randomized controlled trial was conducted. Participants were recruited via advertisements from August to October 2021 in Beijing and were randomly assigned to either an AR self-training CPR group (n=82) or an instructor-led training group (n=81). Participants in the AR group spent 25 minutes in a simulated environment using HoloLens to engage them in immersive multisensory CPR self-training. Participants in the instructor-led group received 25 minutes of CPR instruction with the guidance of a certified instructor. The outcomes, including the mean chest compression depth (centimeter) and rate (/min), the proportion of correct positioning of hands, correct rescue breaths, compression accuracy, and the proportion of participants that adhered to the American Heart Association’s CPR guidelines, were compared between the 2 groups. Results: The median age of the participants was 23 years old (interquartile range: 22–25) and the median weight was 55 kg (interquartile range: 51–63). The mean difference (95% CI) in the compression rate between the 2 groups [mean (SD): AR 109.03 (2.68)/min vs. instructor-led 110.88 (3.03)/min] was −1.85 (−2.74 to −0.96)/min. The mean difference (95% CI) in the depth of compressions between the groups [mean (SD): AR 5.59 (0.59) cm vs. instructor-led 5.55 (0.47) cm] was 0.04 (−0.13 to 0.20) cm. The AR self-training was noninferior to the instructor-led CPR training, as measured by the rate and depth of compressions (P<0.001). The proportion of participants that adhered to the AHA guideline for compression depth (AR: 65.85% vs. instructor: 72.84%, χ2=0.935, P=0.334) was similar in the 2 groups. The proportion of correct rescue breaths [AR: 64 (78.05%) vs. instructor: 74 (91.36%), P<0.001] were significantly higher in the instructor-led group. Heterogeneity of the effect of AR self-training on the chest-compression rate were found in subgroups of sex (P=0.03 for the interaction) and weight (P=0.03 for the interaction). Discussion: The AR self-training and instructor-led training are comparable in terms of both groups’ compression rate and depth. This study may have important implications to improve the CPR training rates in China.

GAMBARAN PELAKSANAAN CPR DENGAN LAGU SORRY - JUSTIN BIEBER TERHADAP KECEPATAN KOMPRESI DADA PADA PENOLONG AWAM

Cardiopulmonary resuscitation (CPR) with a chest compression rate of 100 - 120 beats per minute is difficult without guidance. To maintain chest compression, the rhythm of a song can stabilize CPR rates of 100 - 120 beats per minute. The purpose of this study was to describe the implementation of CPR with the song Sorry-Justin Bieber on the speed of chest compression for lay rescuers. The method uses quantitative research with descriptive design with 30 respondents and uses probability sampling technique with random sampling. The instrument used is a QCPR Training application. Data were analyzed using descriptive statistic. The result of this research are compression speed have an average result of 109,83 beats / minute with a minimum speed of 100, maximum speed of 116, and standard deviation of 5,446. The success rate of respondents in performing chest compression is known to be 30 successful respondents. Hands Only CPR chest compression speed using the song Sorry - Justin Bieber had good results. Variations in the results of chest compression in this study were still within the range of 100 - 120 beats / minute in accordance with high quality CPR standards. This shows the picture that when performing Hands Only CPR with the song Sorry - Justin Bieber, the chest compression speed level will meet the right compression speed standard.

Bystander-witnessed cardiopulmonary resuscitation by nonfamily is associated with neurologically favorable survival after out-of-hospital cardiac arrest in Miyazaki City District.

BackgroundBystander intervention in cases of out-of-hospital cardiac arrest (OHCA) is a key factor in bridging the gap between the event and the arrival of emergency health services at the site. This study investigated the implementation rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) and 1-month survival after OHCA in Miyazaki prefecture and Miyazaki city district as well as compared them with those of eight prefectures in the Kyushu-Okinawa region in Japan. In addition, we analyzed prehospital factors associated with survival outcomes in Miyazaki city district.MethodsWe used data from an annual report released by the Fire and Disaster Management Agency of Japan (n = 627,982) and the Utstein reporting database in Miyazaki city district (n = 1,686) from 2015 to 2019.ResultDespite having the highest rate of bystander CPR (20.8%), the 1-month survival rate (15.7%) of witnessed OHCA cases of cardiac causes in Miyazaki city district was comparable with that in the eight prefectures between 2015 and 2019. However, rates of survival (10.7%) in Miyazaki prefecture were lower than those in other prefectures. In 1,686 patients with OHCA (74 ± 18 years old, 59% male) from the Utstein reporting database identical to the 5-year study period in Miyazaki city district, binary logistic regression analysis demonstrated that age of the recipient [odds ratio (OR) 0.979, 95% confidential interval (CI) 0.964–0.993, p = 0.004)], witness of the arrest event (OR 7.501, 95% CI 3.229–17.428, p < 0.001), AED implementation (OR 14.852, 95% CI 4.226–52.201, p < 0.001), and return of spontaneous circulation (ROSC) before transport (OR 31.070, 95% CI 16.585–58.208, p < 0.001) predicted the 1-month survival with favorable neurological outcomes. In addition, chest compression at a public place (p < 0.001) and by nonfamily members (p < 0.001) were associated with favorable outcomes (p = 0.015).ConclusionsWe found differences in 1-month survival rates after OHCA in the Kyushu-Okinawa region of Japan. Our results suggest that on-field ROSC with defibrillation performed by nonfamily bystanders who witnessed the event determines 1-month neurological outcomes after OHCA in Miyazaki city district. Continued education of citizens on CPR techniques and better access to AED devices may improve outcomes.

Comparison between automated cardiopulmonary resuscitation and manual cardiopulmonary resuscitation in the rescue of cardiac and respiratory arrest.

To compare the efficacy of automated cardiopulmonary resuscitation (A-CPR) and manual cardiopulmonary resuscitation (M-CPR) in the rescue of cardiac and respiratory arrest. A retrospective, single-center observational study was conducted to identify 106 patients by reviewing medical records of 269 patients with cardiac and respiratory arrest treated in The Second Hospital of Hebei Medical University, Shandong Provincial Third Hospital (Jinan, China) from February 2019 to February 2021. Patients were divided into A-CPR group (n = 55) and M-CPR group (n = 51) based on the resuscitation treatment method. The groups were matched for age, gender and the cause of cardiac arrest. Rescue effects, blood gas analysis indicators, respiratory dynamics and condition improvement of the two groups were compared. In terms of rescue effects, return of spontaneous circulation (ROSC) rate, successful rate of cardiopulmonary resuscitation (CPR), 24-hour survival rate and survival discharge rate in the A-CPR group were higher than M-CPR group (P<0.05). With respect to blood gas analysis indicators and respiratory dynamics, the partial pressure of carbon dioxide (PaCO2) in the A-CPR group was lower than M-CPR group at 15 and 30 minutes after CPR, while the partial pressure of oxygen (PaO2), blood oxygen saturation (SaO2), end expiratory carbon dioxide (PetCO2), coronary perfusion pressure (CPP) and mean arterial pressure (MAP) in the A-CPR group were higher than M-CPR group (P<0.05). In aspect of condition improvement, spontaneous breathing, heart rate, spontaneous circulation, blood pressure recovery time and CPR time in the A-CPR group were shorter than M-CPR group (P<0.05). The application effect of A-CPR in the rescue of cardiac and respiratory arrest, the improvement of blood gas analysis indexes, respiration and condition improvement are more significant than M-CPR.

Increasing lay-people’s intentions to initiate CPR in out of hospital cardiac arrest: Results of a mixed-methods ‘before and after’ pilot study of a behavioural text-message intervention (BICeP)

BackgroundPrompt, effective cardio-pulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest. However, CPR is often not provided, even by people with training. Low confidence, perceptions of risks and high emotion can prevent initiation of CPR. Behaviour-change techniques may be helpful in increasing CPR rates. AimTo pilot a text-message behavioural intervention designed to increase intentions to initiate CPR, explore participant responses and pilot methods for future randomised controlled trial of effectiveness. MethodsA ‘before and after’ pilot study plus qualitative interviews was undertaken. Participants were lay-people who had undertaken CPR training in previous 2 years.Participants were sent an intervention, comprising 35 text-messages containing 14 behaviour-change techniques, to their mobile phone over 4–6 weeks.Primary outcome: intentions to initiate CPR assessed in response to 4 different scenarios.Secondary outcomes: theory-based determinants of intention (attitudes, subjective norms, perceived behavioural control and self-efficacy) and self-rated competence. Results20 participants (6 female, 14 male), aged 20–84 provided baseline data. 17 received the full suite of 35 text messages.15 provided follow-up data. Intentions to perform CPR in scenarios where CPR was indicated were high at baseline and increased (18.1 ± 3.2–19.5 ± 1.8/21) after the intervention, as did self-efficacy and self-rated competency. Self-efficacy, attitudes, perceived behavioural control and subjective norms were positively correlated with intentions. Qualitative data suggest the intervention was perceived as useful. Additional options for delivery format and pace were suggested. ConclusionsPilot-testing suggests a text-message intervention delivered after CPR training is acceptable and may be helpful in increasing/maintaining intentions to perform CPR.

Can kids save lives program improve knowledge, skills and attitude of greek students. Preliminary results from three years of implementation

Abstract Background Out of hospital cardiac arrest remains a big issue worldwide, with more than 700.000 deaths annually. Many lives could have been saved if more people had been trained in cardiopulmonary resuscitation. The World Health Organization endorsed the “Kids Save Lives” project in 2015 in order to reduce mortality, while countries, where children were taught cardiopulmonary resuscitation (CPR) in schools, have higher rates of bystander CPR and higher survival rates. Purpose To evaluate the level of theoretical knowledge, willingness to perform Cardiopulmonary resuscitation (CPR) and active skills of Greek secondary school students on the subject of Basic life Support before and after a “Kids Save Lives” program. Moreover to evaluate the potential benefits of training for 3 consecutive years Material and method Data collection took place on the academic periods of 2017–2018, 2018–2019 and 2019–2020 and was performed in secondary schools of Thessaly's region. A total of 5823 students (51,9% female, mean age 14.2 years) participated on the “Kids save Lives” program according to the European Resuscitation Council (ERC) and World Health Organization (WHO) statement. The program was under the approval of Greek Ministry of Education. 709 students followed the program for two consecutive years and 202 for three consecutive years. A 12-question questionnaire was answered by the students before and after the “kid saves lives” program, while practical skills were evaluated on manikins by experienced Basic Life Support Instructors. Results The training improves significantly the theoretical knowledge regarding CPR, with the percentage of correct answers being 48,65%, 63,88%, 75,70% before the first, second and third years respectively (p&amp;lt;0.001). After the course the percentages of correct answers went up to 83,26%, 87,95% and 92,67% after the first, second and third years of the course respectively (p&amp;lt;0.001). The participants willingness to perform bystander CPR significantly increased after the completion of the first year of course (93,8% before to 97,4% after, p&amp;lt;0.001) and remains highly for the next 2 years. Almost all of the participants (98.9%) could recognize the correct position near the victim and 91% performed chin lift maneuver and recognized cardiac arrest. More than 90% of the students performed chest compressions with the correct rate and placing their hands on the center of the chest (90,1% and 93.4%, respectively), whereas only 76.4% of the participants achieved the desired compression depth of 5 to 6 cm. One year later there was improvement to their skills and especially to the desired depth of chest compression (87,6%, p&amp;lt;0,001) Conclusions The overall results strongly depict the benefits of “Kids Save Lives” program by improving the theoretical knowledge, the practical skills and the attitude of Greek students towards CPR and indicate the need for its implementation for 3 consecutive years for every student. Funding Acknowledgement Type of funding sources: None.

Sex differences in the association between bystander CPR and survival for Out-of-Hospital cardiac arrest

BackgroundPrior studies have identified socio-cultural barriers in laypersons performing high-quality cardiopulmonary resuscitation (CPR) in women. Whether the effect of layperson bystander CPR on survival from out-of-hospital cardiac arrest (OHCA) differs by patients’ sex is unknown. MethodsUsing data during 2013–2020 from an OHCA registry in the U.S., we identified adult patients with non-traumatic OHCA. The primary outcome was favorable neurological survival and the secondary outcome was survival to discharge. Multivariable logistic regression models evaluated the interaction between patients’ sex and bystander CPR with survival, adjusted for patient and cardiac arrest characteristics. ResultsOf 420,671 patients with OHCA, 151,145 (35.9 %) occurred in women and 269,526 (64.1 %) in men. Rates of layperson bystander CPR were similar between women (38.3 %) and men (40.0 %). Rates of favorable neurological survival were 11.4 % in those with bystander CPR and 5.6 % in those without, but the association between bystander CPR and favorable neurological survival was weaker for women than men (women: adjusted OR, 1.33 [95 % CI: 1.27–1.39]; men: adjusted OR, 1.55 [95 % CI: 1.51–1.61]; interaction p < 0.001)]. Rates of survival to discharge were 13.1 % and 7.3 % in those with and without layperson bystander CPR, and the association between bystander CPR was weaker for women than men (women: adjusted OR, 1.21 [95 % CI: 1.16–1.26]; men: adjusted OR, 1.43 [95 % CI: 1.39–1.47]; interaction p < 0.001). ConclusionsFor OHCA, bystander CPR was associated with higher survival in women and men. However, as currently practiced, the association between bystander CPR and higher survival was weaker for women as compared with men.

Effect of life-sustaining treatment decision law on pediatric in-hospital cardiopulmonary resuscitation rate: A Korean population-based study

AimThe 2018 life-sustaining treatment (LST) decision law is expected to improve end-of-life quality in Korea. This study evaluated the national effect of the LST decision law on the cardiopulmonary resuscitation (CPR) rate among pediatric patients who died during hospital admission. MethodsThis retrospective cohort study was based on the Korean National Health Insurance database. Pediatric admissions within 12 months before or after implementation of the LST decision law were compared, allowing a 1-month transition period (February 2018). The changes in mortality, CPR, and documentation of LST decision were evaluated. ResultsThe CPR rate of patients who died in hospital decreased after establishment of the LST decision law (49.6 vs 43.4 %, P = 0.04), without change of in-hospital mortality between pre/post-LST decision law activation (0.83 vs 0.81 per 1000 admissions, P = 0.67). In addition, in-hospital CPR (0.73 vs 0.67 per 1000 admissions, P = 0.15) and survival to discharge after in-hospital CPR (43.6 vs 47.2 %, P = 0.27) were slightly improved, although there was no statistical significance. Patients with LST decision documentation were less frequently mechanically ventilated (69.8 % vs 80.4 %, P < 0.01) and used fewer inotropes (76.5 % vs 90.1 %, P < 0.01) and more frequent opioids (67.1 % vs 57.4 %, P = 0.04). ConclusionsThe legally guided process of LST decision can decrease the CPR rate of children who die in hospitals. This result highlights the possibility of improving end-of-life quality by reducing non-beneficial in-hospital CPR.

Estimating the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest burden of disease in the United States.

BackgroundThe impact of the COVID‐19 pandemic on out‐of‐hospital cardiac arrest (OHCA) burden of disease in the United States is unknown. We sought to estimate and compare disability‐adjusted life years (DALYs) lost because of OHCA during the COVID‐19 pandemic to prepandemic values.MethodsDALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). Adult non‐traumatic emergency medical services‐treated OHCA from the Cardiac Arrest Registry to Enhance Survival database for 2016 to 2020 were used to estimate YLL. Cerebral performance category score disability weights were used to estimate YLD. The calculated DALY for the study population was extrapolated to a national level to estimate total US DALY. Data were reported as DALY total and rate. Data for 2020 (pandemic) were compared prepandemic years (2016–2019) via the chi‐square test or t‐test, as appropriate.ResultsA total of 440,438 OHCA met study inclusion criteria. Total OHCA DALY in the United States increased from 4,468,155 (YLL = 4,463,988; YLD = 4167) in 2019 to 5,379,660 (YLL = 5,375,464; YLD = 4197) in 2020. The DALY rate increased from 1357 per 100,000 individuals in 2019 to 1630 per 100,000 individuals in 2020. Bystander cardiopulmonary resuscitation (CPR) rates did not significantly change (47.96% in 2016–2019 vs. 47.89% in 2020; p = 0.157).ConclusionThe overall burden of disease because of adult OHCA increased significantly during the COVID‐19 pandemic. We observed no change in the willingness of layperson bystanders to perform CPR on a national level in the United States.

Application of VIP Care in Patients with Advanced Tumors in the Western Region of China.

Objective The objective of this study is to explore the application of a very important person (VIP) intervention mode in patients with advanced tumors in the western region of China. Methods One hundred and sixty-three patients were randomly divided into a control and experimental groups. The control group received routine care, and the experimental group received VIP future care. The willingness to end-of-life treatment, decision-making certainty, and quality of life were compared between the two groups before intervention (T0), after intervention (T1), and 1 month after intervention (T2). Results There were no significant differences in the basic data of the two groups. Unlike the control group, the experimental group preferred palliative care at the end of T1 (P < 0.05), and the acceptance rate of cardiopulmonary resuscitation and mechanical treatment decreased significantly. After the VIP intervention, the patient was transferred to the intensive care unit (ICU) (P < 0.05). After 1 month of intervention (T2), the results showed that the overall quality of life, physical discomfort, negative emotions, care and support, survival predicament, and lifetime value of the patients were significantly higher than those before the intervention (all P < 0.05). Decision certainty results showed that the differences between the T0, T1, and T2 time points and the interaction between groups and time were statistically significant, and the interaction was more significant at T2 (P < 0.05). Conclusion VIP future care can change patients' wishes for end-of-life care, improve patients' and quality of life, and increase patient decision-making certainty.

Perioperative Problems in Infants Having Pulmonary Hypertension Following Ketamine General Anesthesia

Aim: In adolescents, pulmonary arterial hypertension (PAH) is linked through the substantial postoperative danger of serious problems such as pulmonary severe illness and heart attack. The efficacy of ketamine anesthesia inside this patient group is still unknown. Examine the health information about children having PAH in the past to identify the kind and occurrence of peri-procedural issues, as well as whether ketamine medication been connected to peri-procedural difficulties. Methods: Adolescents having PAH who had general anesthesia for operations throughout the one-year interval (May 2020–April 2021) were eligible to participate. Specifics concerning the patient, PAH, surgery, anesthesia, and post-procedural course were recorded, as well as any untoward events that occurred while or inside 48 hours of the operation. Complication rates were reported separately for each surgery. The relationship among ketamine and peri-procedural problems has been investigated. Results: Seventy-five children (median age 8.4 years, average weight 23 kg) had 193 surgeries performed on them. PAH intensity has been classified as mild (26%), medium (37%), or severe (37%). (41 percent). Medical intervention (n = 21), moderate surgery (n = 28), cardiac catheterization (n = 129), and nonsurgical treatments (n = 18) have been performed. During 152 surgeries, ketamine has been given. Thirty mild problems and nine significant problems reported identified. Cardiac arrest occurred in 0.79 percent of cardiac catheterization operations, 11 percent of significant medical procedures, and 2.7 percent of all processes. There has been no death as a result of the surgery. Ketamine administration was not linked to increases in problems. Conclusion: Ketamine looks to be a safe anesthetic alternative for patients. people suffering from PAH We present data on cardiopulmonary resuscitation rates and significant death rates that are higher than that found. Keywords: Pulmonary Arterial Hypertension, Infants, Hypertension, Cardiac Arrest.

Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics.

Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application. This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics via geolocation matching (N=1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients. Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations; P<0.001), facilities with fewer registered nurses per station (0.29 versus 0.33; P<0.001), and facilities with lower quality scores (# citations 6.8 versus 6.3; P=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41% versus 35%; P<0.001), HIV/hepatitis B, and Medicaid-enrolled patients (15% versus 11%; P<0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black versus White patients persisted (OR=0.45; 95% CI, 0.27 to 0.75). The racial disparity in CPR was greater among older patients compared with younger patients (interaction P=0.04). The racial disparity in CPR delivery within dialysis clinics was not explained by differences in facility resources and quality. Reducing this disparity will require a multifaceted approach, including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.