Recognition Of Cardiac Arrest Research Articles

Knowledge, Attitude, and Practice of the Lebanese University Medical Students and Junior Doctors on Basic Life Support Practices.

Basic life support (BLS) is the recognition of sudden cardiac arrest and activation of emergency response system, followed by cardiopulmonary resuscitation (CPR), and rapid defibrillation. Our study aimed to determine the level of awareness of the Lebanese University medical students and trainees on BLS, by assessing the association between knowledge, attitude, and practice on BLS, and between the demographic variables and KAP scores. This was a cross-sectional study including 330 medical students enrolled at Lebanese University, from year four of general medicine till year five of residency. An online survey was used to collect data about demographic characteristics, knowledge (K), attitudes (A), and practice (P) about BLS. Data was analyzed using SPSS version 25. Participants were 52.7% females, 47.3% males, and their mean age was 24 ± 2 years. Of the 330 participants, 38.8% received formal training regarding BLS. Medical students had low knowledge (90%), moderate to good attitudes (71.5%), and low practice (93%) regarding BLS. Multiple linear regression showed that knowledge was positively associated with age (p = 0.001), knowledge and information regarding BLS (p = 0.016), and any formal training/workshop regarding BLS (p = 0.021). Attitude was positively associated with academic year (p = 0.002) and knowledge (p = 0.003). Practice was positively associated with age (p < 0.001) and knowledge (p < 0.001). Most Lebanese University medical students showed low knowledge, moderate to good attitudes, and low practice regarding BLS. We recommend that CPR/BLS should be a core competency across all health care professional programs.

Abstract Su908: Unfavorable prognostic features and temporal trends in Out-of-Hospital Cardiac Arrests (OHCA) presenting to an Academic Center at the Border in El Paso

Introduction: Early recognition of cardiac arrest with bystander cardiopulmonary resuscitation (CPR), and early defibrillation when appropriate, can improve outcomes after Out of Hospital Cardiac Arrest (OHCA). Data from the national registries indicate there are both regional as well racial and ethnic differences in rates of bystander CPR in witnessed OHCA cases with significantly lower rates of bystander CPR in non-white persons. However, Hispanic as well border populations are underrepresented in these studies. University Medical Center (UMC) El Paso, Texas is an academic medical center located 1 mile from the US- Mexico border which is also the only not for profit safety net hospital with a Level1 trauma center. Research Question: Outcomes after OHCA are strongly affected by peri-arrest circumstances including bystander CPR and certain features portend poor outcomes. We performed a descriptive observational study of OHCA cases presenting to UMC to analyze temporal trends in these factors in our community as local data from El Paso is currently not reported in any registries. Methods: We collaborated with the El Paso Fire Department (EPFD) to obtain resuscitation data on patients who suffered OHCA and were brought to the University Medical Center (UMC)Emergency Department (ED) and created a registry of patients who suffered OHCA in El Paso FROM 2017 to Nov 2021. Results: Initial analysis identified around 698 predominantly Hispanic patients who suffered OHCA. Of these 115 were due to non-cardiac causes such as trauma, and 583 were possible cardiac etiology. OHCA cases peaked in 2020 coinciding with COVID 19 surge. Less than one third (31.5%) had bystander CPR with only 11.9% having a shockable rhythm. 64% did not achieve Return of spontaneous circulation in the field. 39% expired in the ED or in the field. We also performed a temporal analysis of these features and bystander CPR rates peaked in 2019 (38.1%to 24.8% in 2021). Conclusion: In our Hispanic underserved population in El Paso, we identified poor outcomes after OHCA, with non-shockable rhythm being the most common adverse feature and decreased rates of bystander CPR (31.5%) with further decrease after 2019. Local community level data which is critical for appropriate local resource allocation to improve OHCA outcomes is missing from underserved populations and additional resources are required improve outcomes.

Does Real-time Feedback Guide Devices Improve the Quality of Chest Compressions in the Bystander (Naves) Provider?

Abstract Introduction: Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that must taught to everyone. As most cardiac arrests occur outside of the hospital, training the general population in the recognition of cardiac arrest and performing high-quality CPR is vital. Thus, this study aimed to compare the chest compression quality data (rate, depth, and fraction) with and without the use of feedback devices during CPR. Methods: A crossover observational study was carried out at a tertiary hospital in September 2021. Five hundred and seventeen 1st-year university students were recruited, and the response rate was 90% (465). A feedback device was used to collect data. The data were numerically coded and statistical software (SPSS 21) was used to perform descriptive and inferential statistical analysis, including a paired t-test. Results: The mean compression rate with feedback was statistically significantly lower after performing one cycle of CPR (mean difference: −5.610; 95% confidence interval [CI]= −7.987–−3.233; P &lt; 0.001), the difference between mean compression depth with and without feedback was not statistically significant (mean difference: = −0.006; 95% CI = −0.190–0.177; P = 0.944), and the mean compression target (%) with feedback was statistically significantly higher (mean difference: −15.951; 95% CI = −17.894–−14.009; P &lt; 0.001). Conclusions: We found that the use of feedback devices during layperson-simulated CPR scenarios significantly improved the quality of chest compression in terms of depth and rate and resulted in more guidelines adherence. Moreover, national programs for CPR education should be implemented.

Benefits of Virtual Reality Training for Cardiopulmonary Resuscitation Skill Acquisition and Maintenance

Objectives To investigate the benefits of virtual reality (VR) first-aid training in acquiring cardiopulmonary resuscitation (CPR) skills. Methods A total of 100 non-medical professional volunteers from Nanchang were selected in March 2021 using the convenience sampling method. They were randomly divided into two groups: the VR training group (VR group) and the traditional simulation scenario training group (traditional group). The VR Group underwent immersive virtual reality CPR training with interactive feedback, while the Traditional Group received standard simulation-based CPR training using mannequins and instructor guidance. After training, relevant data were collected for comparative analysis. Results The study revealed that the VR group consistently outperforming the traditional group in theoretical knowledge test (cardiac arrest recognition, chest compressions, airway management, and artificial respiration) scores at 1, 3, 6, and 12 months post-training (p < 0.05). Similarly, the VR group showed superior performance in overall skills test scores and individual CPR quality metrics at all post-training assessments. The VR group scored higher in total skills, assessment, post-resuscitation assessment, chest compressions (at 1, 3, and 6 months), airway opening, and artificial respiration compared to the traditional group (p < 0.05). Despite these findings, both groups exhibited a gradual decrease in skills test scores over time. Conclusions Virtual reality training can significantly improve non-medical professional volunteers’ CPR knowledge and skill levels, helping them master and maintain these competencies. However, a decrease in CPR knowledge and skills among the participants over time was observed after VR training, suggesting the need for further retraining sessions.

RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial: Study rationale and design

Out-of-hospital cardiac arrest (OHCA) occurs in nearly 350,000 people each year in the United States (US). Despite advances in pre- and in-hospital care, OHCA survival remains low and is highly variable across systems and regions. The critical barrier to improving cardiac arrest outcomes is not a lack of knowledge about effective interventions, but rather the widespread lack of systems of care to deliver interventions known to be successful. The RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial is a 7-year pragmatic, cluster-randomized trial of 60 counties (57 clusters) in North Carolina using an established registry and is testing whether implementation of a customized set of strategically targeted community-based interventions improves survival to hospital discharge with good neurologic function in OHCA relative to control/standard care. The multi-faceted intervention comprises rapid cardiac arrest recognition and systematic bystander CPR instructions by 9-1-1 telecommunicators, comprehensive community CPR training and enhanced early automated external defibrillator (AED) use prior to emergency medical systems (EMS) arrival. Approximately 20,000 patients are expected to be enrolled in the RACE CARS Trial over 4 years of the assessment period. The primary endpoint is survival to hospital discharge with good neurologic outcome defined as a cerebral performance category (CPC) of 1 or 2. Secondary outcomes include the rate of bystander CPR, defibrillation prior to arrival of EMS, and quality of life. We aim to identify successful community- and systems-based strategies to improve outcomes of OHCA using a cluster randomized-controlled trial design that aims to provide a high level of evidence for future application.

Knowledge and attitudes towards performing resuscitation among seniors - a population-based study

BackgroundCardiac arrest constitutes a critical medical emergency necessitating swift intervention to reinstate normal heart rhythm and prevent harm to vital organs. The pivotal role of bystander cardiopulmonary resuscitation (CPR) in influencing survival rates is well recognized. With older adults being the most common group to witness such events, it’s curcial to understand their attitudes and knowledge about performing CPR. Additionally, understanding if health status has an influence can help in tailoring education for specific seniors needs.MethodsA cross-sectional survey was sent to University of the Third Age (UTA) students. The survey comprised sections focusing on demographic data, CPR knowledge, automated external defibrillator (AED) knowledge, first aid training, and readiness to perform CPR and use AEDs. Participants’ health conditions were also assessed through multiple-choice options.ResultsWe received 456 responses. Significant awareness of emergency numbers and cardiac arrest recognition was revealed. However, knowledge gaps persisted, particularly in compression rates. Most participants comprehended AED usage, yet training primarily relied on theoretical approaches. Health conditions notably affected CPR readiness, with associations between specific chronic diseases and willingness to perform CPR.ConclusionsAddressing knowledge gaps and tailoring education for elderly needs are crucial for improving survival rates. Future research should explore barriers to bystander CPR during out-of-hospital cardiac arrests to further enhance survival prospects.

The "Weekend Effect" in Extracorporeal Cardiopulmonary Resuscitation.

The phenomenon known as the "weekend effect" impacts various medical disciplines. We compared outcomes between regular hours and off hours to investigate the presence of the weekend effect in extracorporeal cardiopulmonary resuscitation (ECPR). Between January 2018 and December 2020, 159 patients at our center were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) for cardiac arrest. We assessed the time required for ECMO preparation, the rate of successful weaning, and the rate of in-hospital mortality. These factors were compared among regular hours ("daytime": weekdays from 7:00 AM-7:00 PM), off hours on weekdays ("nighttime": weekdays from 7:00 PM-7:00 AM), and off hours on weekends and holidays ("weekend": Fridays at 7:00 PM to Mondays at 7:00 AM). The time from the recognition of cardiac arrest to the arrival of the ECMO team was shortest for the daytime group and longest for those treated over the weekend (daytime, 10.0 minutes; nighttime, 12.5 minutes; weekend, 15.0 minutes; p=0.064). The time from the ECMO team's arrival to ECMO initiation was shortest for the daytime and longest for the nighttime group (daytime, 13.0 minutes; nighttime, 18.5 minutes; weekend, 14.0 minutes; p=0.028). No significant difference was observed in the rate of successful ECMO weaning (daytime, 48.3%; nighttime, 39.5%; weekend, 36.1%; p=0.375). In situations involving CPR, the time to arrival of the ECMO team was longer during off hours. Furthermore, ECMO insertion required more time at night than during the other periods. These findings warrant specific training in decision-making and emergent ECMO insertion.

Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study.

Public access defibrillation (PAD) programs have been implemented globally over the past decade. Although PAD can substantially increase the survival of cardiac arrest, PAD use remains low. This study aimed to evaluate whether drawing upon the successful experiences of dispatcher-assisted cardiopulmonary resuscitation programs would increase the use of PAD in dispatcher-assisted PAD programs. This study using a before-and-after design was conducted in Taoyuan City using a local out-of-hospital cardiac arrest registry system and data of dispatcher performance derived from audio recordings. The primary outcomes were the rate of bystander PAD use, sustained return of spontaneous circulation, survival to discharge, and favorable neurological outcomes. The secondary outcomes were the performance of dispatchers in terms of PAD instruction and dispatcher-assisted cardiopulmonary resuscitation administration, the time interval indicators of dispatcher-assisted cardiopulmonary resuscitation. A total of 1159 patients were included and divided into 2 groups: the before-run-in group (502 patients) and the after-run-in group (657 patients). No significant difference was observed between the 2 groups in terms of baseline characteristics. The rate of PAD use in the after-run-in group significantly increased from 5.0% to8.7% (P=0.015). The rate of favorable neurological outcomes increased from 4.4% to 5.9%, which was not a statistically significant difference. Compared with the before-run-in group, the rate of successful automated external defibrillator acquisition was 13.5% in the after-run-in group (P<0.001). Implementing a dispatcher-assisted PAD protocol in a municipality setting significantly increased bystander PAD use without affecting dispatcher performance in out-of-hospital cardiac arrest recognition, cardiopulmonary resuscitation instruction, or dispatcher-assisted cardiopulmonary resuscitation time indicators.

Pediatric Out-of-Hospital Cardiac Arrest: The Role of the Telecommunicator in Recognition of Cardiac Arrest and Delivery of Bystander Cardiopulmonary Resuscitation.

Telecommunicator CPR (T-CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out-of-hospital cardiac arrest (OHCA). Little is known about this treatment strategy in the pediatric population. We investigated the role of T-CPR and related performance among pediatric OHCA. This study was a retrospective cohort investigation of OHCA among individuals <18 years in King County, Washington, from April 1, 2013, to December 31, 2019. We reviewed the 911 audio recordings to determine if and how bystander CPR was delivered (unassisted or T-CPR), key time intervals in recognition of arrest, and key components of T-CPR delivery. Of the 185 eligible pediatric OHCAs, 23% (n=43) had bystander CPR initiated unassisted, 59% (n=109) required T-CPR, and 18% (n=33) did not receive CPR before emergency medical services arrival. Among all cases, cardiac arrest was recognized by the telecommunicator in 89% (n=165). Among those receiving T-CPR, the median (interquartile range) interval from start of call to OHCA recognition was 59 seconds (38-87) and first CPR intervention was 115 seconds (94-162). When stratified by age (≤8 versus >8), the older age group was less likely to receive CPR before emergency medical services arrival (88% versus 69%, P=0.002). For those receiving T-CPR, bystanders spent a median of 207 seconds (133-270) performing CPR. The median compression rate was 93 per minute (82-107) among those receiving T-CPR. T-CPR is an important strategy to increase early recognition and early CPR among pediatric OHCA.

Dispatchers trained in persuasive communication techniques improved the effectiveness of dispatcher-assisted cardiopulmonary resuscitation

BackgroundEarly recognition of cardiac arrest and early initiation of bystander cardiopulmonary resuscitation can increase the survival of patients with out-of-hospital cardiac arrest (OHCA). We compared dispatcher-assisted cardiopulmonary resuscitation (DACPR) effectiveness before and after using different communication models in the dispatching center. MethodWe analyzed dispatch recordings of non-trauma origin OHCA cases received by the Taichung dispatch center between May 1 to September 30, 2021, and November 1, 2021, to March 31, 2022. The dispatchers underwent an 8-hour training intervention consisting of targeted education using a new communication model for DACPR. Several outcome measures were evaluated, including the sustained return of spontaneous circulation and the time to first chest compression. ResultsWe included 640 cases in the preintervention group and 580 cases in the postintervention group. The return of spontaneous circulation (ROSC) rate, the time to first chest compression, and good neurological outcome were significantly improved in the postintervention group (20.9% vs. 31.0%, p < 0.001;168 seconds vs. 151 seconds, p = 0.004; 2.8% vs. 5.3%, p = 0.024, respectively). In subgroup analyses, the intervention was related to a statistical improvement in ROSC rate among patients whose caller was a family member (18.7% vs. 31.4%, p < 0.001). Among patients whose caller was female, both ROSC and good neurological outcome significantly improved after the intervention (19.8% vs. 36.6%, p < 0.001; 2.7% vs. 7.5%, p = 0.006, respectively). There was a statistical difference between the pre-intervention and post-intervention group with respect to ROSC rate among patients whose caller was family (the adjusted odds ratio:1.78, 95% CI: 0.59–1.25], p < 0.001.) or female (the adjusted odds ratio:3.18,95% CI: 1.77–5.70], p = 0.008.) in the multivariable regression model. ConclusionThe new communication model has enhanced the effectiveness of DACPR in terms of the ROSC rate, particularly when the caller was a family member or female, leading to improved rates of ROSC and favorable neurological outcomes.

Assessment of Cardiopulmonary Resuscitation Knowledge Among Physicians in the Pediatrics Department of an Urban Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study.

Background: Early recognition of cardiac arrest and prompt start of cardiopulmonary resuscitation (CPR) boost survival rates and reduce postarrest consequences. Little information is available about the fundamental CPR knowledge of healthcare workers who work with children in Ethiopia. Methods: All physicians, regardless of seniority, participated in this cross-sectional survey from June to August 2022. They received a structured survey that was modified from the American Heart Association (AHA) Basic Life Support (BLS) test which was made up of 10 questions about participants' job experience and 25 multiple-choice CPR knowledge questions. Data analysis was done using a multinomial logistic regression test with a p value of 0.05. Result: One hundred sixty-eight doctors with various levels of seniority participated in this study. The participants included a male-to-female ratio of 1.3:1, a median age of 28 years, 92 (57.9%) male participants, and 124 (78%) participants with less than 5 years of clinical experience. Ninety-seven participants, or 61%, had scored less than 75% whereas 13 (8.2%), participants, had good knowledge that is scoring above 75%. Participants who had training in CPR within the previous year showed significantly higher levels of knowledge than those who hadn't. Even though 90% of the participants claimed to have CPR knowledge, the majority of participants were found not to have below 75%. Conclusion: The study concludes that while many doctors believe they have adequate CPR knowledge, actual knowledge levels are insufficient. Staff should undergo regular certification and assessments to ensure they retain their resuscitation knowledge. This ongoing evaluation is crucial for maintaining high standards of care and preparedness in emergencies.

151 Defining the appropriate age for the implementation of “Kids Save Lives” project. Results regarding the recognition of cardiac arrest

151 Defining the appropriate age for the implementation of “Kids Save Lives” project. Results regarding the recognition of cardiac arrest

Education of schoolchildren in cardiopulmonary resuscitation - overview of the current literature.

Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low bystander CPR rates. Thereby, schoolchildren CPR training evolved as own scientific field within the last decade. Aim was to describe current evidence in terms of epidemiology, teaching approaches and political aspects. Schoolchildren demonstrate a high motivation to be trained in CPR. Teaching approaches that combine theoretical and practical learning sessions guarantee a sustainable learning effect. Schoolchildren can adequately perform chest compressions and mouth-to-mouth ventilation from the age of 12 years. Use of digital media is a highly promising teaching approach. CPR training conducted by teachers from the own school is effective and guarantees continuous development of CPR skills. Integration of schoolchildren CPR training into school curricula is the foundation for a sustainable increase of lay resuscitation rates in the population. Scientific and political promotion of schoolchildren CPR training is needed to sensitize the population and move bystander CPR in the social focus. While bystander CPR rates are low in Europe comprehensive establishment of schoolchildren CPR training may sustainably increase survival after cardiac arrest.

Impact of post-dispatch advice on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Hong Kong

Background: In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. Method: We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. Results: The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p &lt; 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p &lt; 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Conclusion: Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.

Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery.

Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines. The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy. Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.

C34 AN UNUSUAL CASE OF CARDIAC ARREST DUE TO TRAUMA–INDUCED QT PROLONGATION

Abstract Background QT prolongation is a well–known cause of sudden cardiac death due to polymorphic ventricular tachycardia triggered by early afterdepolarizations. Acquired long QT is a common finding in several clinical scenarios and invariably represents a high risk feature. Case Report An 84 years–old woman presented to our emergency department (ED) after experiencing a blunt chest trauma due to a car accident. She reported mild dyspnea and chest pain exacerbated by breathing and movement while denied palpitations and loss of consciousness. Baseline ECG showed atrial fibrillation with normal ventricular rate and a prolonged QT interval (QTc 640, Fig 1A) not present at previous ECGs. She did not assume any QT–prolonging drug and laboratory tests at admittance revealed troponin I values slightly elevated (29,6 ng/ml; n.v.: &amp;lt;11,6 ng/l) and no other significant abnormalities. A CT scan demonstrated a displaced fracture of the sternal body. Due to the QT prolongation, the patient was admitted for ECG monitoring.. During the stay in our ED the patient suffered a cardiac arrest. A torsade des pointes triggered by a late–coupled premature ventricular complex (PVC) was documented (Fig 1B). The arrhythmia was interrupted with external DC shock and magnesium solfate infusion was started. The coronary angiography demonstrated normal coronary arteries. The patient underwent cardiac magnetic resonance (CMR) four days later which showed transmural necrosis of the middle third of the lateral wall of the left ventricle at the insertion of the anterolateral papillary muscle (Fig 2). No further ventricular arrhythmias were observed and the patient was discharged after QTc normalization. Cardiac arrhythmias are a rare complication of cardiac contusion ranging from isolated PVCs to atrial or ventricular fibrillation. However, the role of the ECG in this peculiar subset is unclear. The most common ECG abnormalities are non specific ST–T wave changes, whereas in our case the marked QTc prolongation resulted in a closer monitoring of the patient allowing a prompt recognition of cardiac arrest. On the other hand CMR proved to be an effective method to identify a cardiac injury showing the typical pattern of myocardial damage associated with cardiac contusion (stress–induced lesions at the insertions of papillary muscles due to sudden increase of left ventricular pressure) and, thus, could be adopted as a useful tool to identify patients at higher risk for arrhythmic complications.

The experience of online cardiac arrest video use for education and research: A qualitative interview study completed in partnership with survivors and co-survivors

BackgroundSwift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one’s cardiac arrest recorded and available online. MethodsWe gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project. FindingsWe identified themes of ‘shock, hurt and helplessness’ and ‘surreality and reality’ to describe the experience of having one’s (or a family member’s) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice. ConclusionsFinding one’s own, or a family member’s cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.

Sex differences in anxiety and hesitation toward bystander CPR and AED

Women who suffer out-of-hospital cardiac arrest receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) less frequently than that of men. Understanding the public perception on the necessity of the occurrence of life-saving disparities for fair intervention application to individuals with injuries and sickness is needed. The participants were undergraduate students of the university. Anxiety and irritability towards bystander CPR and AED operations were investigated. The participants of the analysis were 368 individuals (153 men and 215 women), of which 80.4% of men and 95.8% of women had anxiety about life-saving procedures. Regarding AED operation, 90 (58.8%) men and 74 (34.4%) women hesitated on removing clothing from a woman with injury or sickness. The reasons on women with injury and illness were less likely to be suitable with AEDs involved anxiety about life-saving procedures, litigation issues, and posting and spreading on social networking sites (SNS). Particularly, if men intervened with women with wounds, the main limitations were the risk of the act developing into a lawsuit and gaze of others, namely SNS. Bystander anxiety towards life-saving procedures was found to be strongly expressed by women. It also became evident that early recognition of cardiac arrest was not performed for patients with injuries 20–30% of the time. Training specifically for women with wounds and sickness may reduce sex differences in bystander CPR and AED application.

Abstract 311: Performance of Video-assisted Cardiac Arrest Recognition Protocol for Emergency Medical Dispatch in Out-of-hospital Cardiac Arrest

Introduction: Cardiac arrest recognition in emergency medical dispatch (EMD) is an important process for initiation of telephone CPR that could lead to bystander CPR before emergency medical service (EMS) arrival. Video-assisted protocol was developed and implemented for better recognition of cardiac arrest suspected calls that recognition was uncertain under conventional audio-call dispatch. We tested the performance of video-assisted protocol after pilot implementation in a dispatch center. Methods: All emergency medical dispatch calls received by Seoul emergency dispatch center that used video-assisted recognition protocol from Jun. 2020 to Dec. 2020 were enrolled. The primary outcome was the presence of cardiac arrest at EMS arrival evaluated by EMS providers arrived at the scene. The predictive performance measure of video-assisted protocol was calculated including sensitivity and specificity with 95% confidence interval (CI). Result: During the study period, video-assisted protocol was used in 115 emergency calls that dispatchers were uncertain during initial audio-call. In 15 cases the dispatcher additionally recognized the case as cardiac arrest under video-assistance. Of recognized cases, 14 (93.3%) cases were cardiac arrest when EMS arrived at scene. The sensitivity (95% CI) and the specificity (95% CI) of video-assistance protocol were 63.6% (40.7 - 82.8) and 98.9% (94.2 - 100) respectively. Conclusion: Use of video-assisted protocol helped recognizing additional cardiac arrest cases that could not be recognized with the audio-call in the dispatch center. Technological and operational improvement should be continuously studied for better cardiac arrest recognition using video-assisted protocol during emergency call taking.

Paediatric manikins and school nurses as Basic Life Support coordinators: A useful strategy for schools?

Objective: To evaluate cardiopulmonary resuscitation (CPR) skills performance and retention in schoolchildren aged 8 to 12 years following instruction by their teachers and with the guidance of a school nurse using paediatric manikins. Design: Descriptive simulation trial. Method: A school nurse provided support to six schoolteachers as they taught a modified 40-minute CPR course. Pupils were shown an out-of-hospital cardiac-arrest recognition video followed by a CPR simulation using paediatric manikins. 117 schoolchildren aged 8 to 12 years received the training. Both the schoolchildren and teachers completed a survey before and afterwards. Children completed an out-of-hospital cardiac-arrest recognition test and a 1-minute CPR test 1 week later. Results: After training, schoolchildren increased their self-efficacy as rescuers (8 ± 2 vs 10 ± 2; p &lt; 0.001). Irrespective of age differences, 74% of schoolchildren performed the entire out-of-hospital cardiac-arrest recognition sequence correctly. Children aged 11 to 12 years and 10 to 11 years performed higher quality CPR (49% and 47%, respectively) compared to 8 to 9 year olds (14%, p = 0.008 and p = 0.014). Children aged 11 to 12 years outperformed younger children aged 8 to 9 years with respect to compression depth (48 ± 6 mm vs 43 ± 5 mm, p = 0.008) Conclusion: Schoolchildren’s teachers, who were guided by a nurse using paediatric manikins, taught children aged 10 to 12 years to perform high-quality CPR. We suggest integrating paediatric manikins as part of children’s CPR training as feedback from successful CPR performance increases motivation and confidence to act as a rescuer as well as improves skills retention.