Resuscitation Performance Research Articles

Factors associated with post-traumatic stress symptoms in healthcare providers after performance of cardiopulmonary resuscitation: a mixed-methods study

The experience of performing cardiopulmonary resuscitation (CPR) can cause post-traumatic stress symptoms that negatively impact healthcare providers and reduced their clinical competency. This two-phase mixed-methods was conducted to investigate the factors that cause post-traumatic disorder (PTSD) in healthcare providers who perform CPR. Phase 1 included a survey with a trauma screening questionnaire (TSQ). Phase 2 included gathering interview data and applying conventional content analysis to identify themes. Of the 286 medical staff who completed the TSQ, 32 (11.2%) of respondents experienced PTSD after administering CPR. PTSD occurred significantly more frequently in nurses than in doctors. Among nurses, those with 2–5 years of experience were the most likely to experience PTSD. From the content analysis of the interview data, four themes with twelve subthemes emerged: Healthcare providers were not prepared for CPR, Difficulties faced during CPR administration, Negative emotions experienced after performing CPR, and Overcoming stress and moving forward. The occurrence of PTSD is associated with negative experiences in each stage of the event: before-, during-, and after-CPR. Therefore, to avoid or overcome PTSD caused by performing CPR, systematic and customized intervention strategies suitable for each stage of the process are needed.

To intubate or to resuscitate: the effect of simulation-based training on advanced airway management during simulated paediatric resuscitations.

We aimed to measure the effect of a 2-day structured paediatric simulation-based training (SBT) on basic and advanced airway management during simulated paediatric resuscitations. Standardised paediatric high-fidelity SBT was conducted in 12 of the 15 children's hospitals in Hesse, Germany. Before and after the SBT the study participants took part in two study scenarios (PRE and POST scenario), which were recorded using an audio-video system. Airway management was assessed using a performance evaluation checklist. Time to initiate ventilation, frequency, and timing of endotracheal intubation (ETI), and its influence on other life support interventions were assessed. Differences in airway management between hospitals with and without a PICU were evaluated. Two hundred twenty-nine participants formed 58 interprofessional resuscitation teams. All teams recognised apnoea in their simulated patients and initiated ventilation during the scenarios. Time to recognition of apnoea and time to initiation of ventilation did not improve significantly after SBT, but teams were significantly more likely to select appropriately sized airway equipment. ETI was attempted in 55% PRE and 40% POST scenarios (p=0.1). The duration of the entire ETI process was significantly shorter in the POST scenarios. Chest compressions (CC) were frequently discontinued during ETI attempts, which improved after SBT (PRE 73% vs. POST 43%, p = 0.035). Adequate resumption of CC after completion of intubation was also significantly more frequent in the POST scenarios (46% vs. 74%, p = 0.048). During ETI attempts, CC were more likely to be adequately continued in teams from hospitals with a PICU (PRE scenarios: PICU 20% vs. NON-PICU 36%; POST scenarios: PICU 79%, NON-PICU 22%; p < 0.01). Our data suggest an association between airway management complexity and basic life support measures. Although the frequency of ETI was not significantly reduced after a 2-day SBT intervention, the duration of advanced airway management was shortened thus reducing no-ventilation time which led to fewer interruptions in chest compressions during simulated paediatric resuscitations. SBT may be adapted to the participants' workplace to maximize its effect and improve the overall performance in paediatric resuscitation.

In situ simulation for cardiopulmonary resuscitation training: A systematic review.

To evaluate the effectiveness of in situ simulation for cardiopulmonary resuscitation (CPR) training on clinical and educational outcomes. Randomised controlled trials (RCT) and non-randomised studies evaluating in situ simulation for cardiopulmonary resuscitation CPR training of healthcare workers in any setting compared to traditional training and reporting data on patients' survival, patients' outcomes, clinical performance and teamwork in actual or simulated resuscitation and resources needed were included. PubMed, Embase and Cochrane were searches from inception to October 28th 2024 (PROSPERO CRD42024521780). The assessment of risk of bias was done using RoB2 or ROBINS-I and the certainty of evidence was assessed by the GRADE approach. Meta-analysis was not possible due to significant heterogeneity in setting, interventions, control, and outcome definitions. The evidence was summarised according to the Synthesis Without Meta-Analysis (SwiM) reporting guidelines. No funding has been obtained. From 1062 records, 10 articles were included after full-text review (4 RCTs, 6 non-randomised). The risk of bias was judged as high or some concerns for RCTs and critical or serious for non-randomised studies. The certainty of evidence was very low for all the evaluated outcomes mainly due to risk of bias, inconsistency and imprecision. Two non-randomised studies reported data on patient survival, while two other non-randomized studies provided data on the review outcome of 'patient outcomes', suggesting a potential benefit of in situ simulation or no difference. Four non-randomised studies reported improving or no difference in clinical performance in actual resuscitation. One study reported improved teamwork in actual resuscitation while another reported no difference. Most included studies reported improved clinical performance, teamwork and CPR skill in simulated resuscitation after in situ simulation training vs. traditional training. No study evaluated the resources needed. The heterogenous evidence suggests that in situ simulation should be considered as an option for CPR training. The certainty of evidence is very low and cost-benefit balance is uncertain due to lack of data about resource needed.

Impact of Middle-Aged Adults' Recognition of Early Myocardial Infarction Symptoms and Training Experience on Cardiopulmonary Resuscitation Performance: A Cross-Sectional Study.

Despite the increasing incidence of myocardial infarction among middle-aged adults, studies analyzing their recognition of early myocardial infarction symptoms and cardiopulmonary resuscitation training experiences are lacking. This study aimed to utilize data from the 2022 Korea Community Health Survey to assess the level of recognition of early myocardial infarction symptoms among middle-aged adults and identify factors affecting cardiopulmonary resuscitation performance based on training experiences. Secondary data analysis was conducted to assess 99,945 adults aged 40-64 years on their recognition of early myocardial infarction symptoms and the influence of cardiopulmonary resuscitation training experience on their performance ability. Data analysis was performed using multinomial logistic regression, followed by assessing the area under the curve and visualizing the receiver operating characteristic curve to evaluate the model's performance. The recognition of early myocardial infarction symptoms improved; the cardiopulmonary resuscitation performance ability increased by 22%. The absence of training with mannequins and automated external defibrillators resulted in a 79% and 77% decrease in cardiopulmonary resuscitation performance ability, respectively. Enhancing the recognition of early myocardial infarction symptoms and providing hands-on cardiopulmonary resuscitation training is vital for improving cardiopulmonary resuscitation performance in middle-aged adults. Effective cardiopulmonary resuscitation training programs can facilitate the rapid identification of patients who have had a cardiac arrest, bolster emergency response capabilities, and enhance the overall social safety net.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive. This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study. Patient serum was analyzed via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect opioids, novel psychoactive substances, and adulterants. Patients were separated into groups of those with tramadol detected versus no tramadol detected. Differences in naloxone administration, intubation, performance of cardiopulmonary resuscitation (CPR), or death between those exposed or not exposed to tramadol were evaluated. From September 21, 2020 - October 31, 2021; 2298 patients were screened and 537 met inclusion criteria. Eighty-one patients (15%) tested positive for tramadol. There was no significant difference found between those who reported chronic prescription opioid use (p=0.81) or reported chronic pain (p=0.27). Additionally, no difference was found between groups in the number of patients receiving a single, second, or third dose of naloxone (p=0.25; 0.92; 0.59) or the proportion initiated on a naloxone infusion (p=0.84). Similarly, there was no difference in outcomes of intubation, CPR, or death (p=0.26; 0.75; 0.29). Tramadol was identified in a subset of patients presenting to the Emergency Department with opioid overdoses suggesting adulteration of illicitly manufactured fentanyl with tramadol. Its presence was not associated with a lack of treatment response, difference in severity of overdose, or increased risk of complications.

Trauma video review analysis: Increased provider movement impedes trauma team performance

IntroductionTrauma team performance, measured by the non-technical skills scale T-NOTECHS, has been shown to impact patient outcomes. We assess how personnel movements affect non-technical skills and time of resuscitation(TOR) using trauma video review. MethodsA prospective study of blunt and/or penetrating trauma activations recorded between May and November 2023 ​at a Level-I trauma center. Regressions controlling for confounders were used to measure the association between foot traffic and the outcomes of interest1: TOR2 T-NOTECHS score(Smith et al., 2015; Mackenzie et al., 2007; Maiga et al., 2024; Vella et al., 2024; Pucher et al., 2014; Dumas et al., 2020; Succar et al., 2024; Steinemann et al., 2012; Andersson et al., 2012; Conrad et al., 2010; Lies and Zhang, 2015) .5-155-15 ResultsWe identified 77 trauma activations, with 40 ​%(n ​= ​32/77) penetrating injuries. There was a median of 17[14–18] individuals at the start of trauma activations. During resuscitations, individuals entered the room a median of 12[8–18] times and exited the room 17[11–22] times. The median TOR was 8[6–10] min and the median T-NOTECHS was 7[6–8]. Regression analysis showed foot traffic was independently associated with increased TOR(β 0.34, p-value <0.01) and worse total T-NOTECHS score(β 0.06, p ​< ​0.01). ConclusionsHigher foot traffic is associated with poorer team performance and delays in resuscitation. Future directions should further explore environmental and personal factors that may impede performance metrics.

A Pilot Randomized Controlled Study to Determine the Effect of Real-Time Videos With Smart Glass on the Performance of the Cardiopulmonary Resuscitation.

The aim of this study was to determine the effect of real-time videos with smart glasses on the performance of cardiopulmonary resuscitation performed by nursing students. In this randomized controlled pilot study, the students were randomly assigned to the smart glass group (n = 12) or control group (n = 8). Each student's cardiopulmonary resuscitation performance was evaluated by determining sequential steps in the American Heart Association algorithm they applied and the accuracy and time of each step. A higher number of participants correctly checked response breathing, requested a defibrillator, activated the emergency response team, and provided appropriate chest compressions and breaths in the smart glass group than the control group. There were significant differences between groups. Furthermore, more participants significantly corrected chest compression rate and depth and hand location, used a defibrillator, and sustained cardiopulmonary resuscitation until the emergency response team arrived in the smart glass group than in the control group. Additionally, a significantly shorter time was observed in the smart glass group than in the control group in all variables except time to activate the emergency response team (P < .05). Remote expert assistance with smart glass technology during cardiopulmonary resuscitation is promising. Smart glass led to a significantly better ABC (airway, breathing, circulation) approach, chest compression depth and rate, and hand position. Furthermore, remote expert assistance with smart glass has the potential to improve overall resuscitation performance because it enabled students to initiate resuscitation, use a defibrillator, and defibrillate patients earlier. Nurses may benefit from smart glass technology in real life to provide effective cardiopulmonary resuscitation.

Survivability of young sudden cardiac arrest by aetiology: insights from a state-wide adjudicated cardiac arrest registry

Abstract Background Identifying factors to improve survival following out-of-hospital cardiac arrest (OHCA) is important. Many OHCA registries do not document the underlying cause of OHCA and therefore cannot provide insights according to specific arrest aetiology. The aim of this study was to assess survivability of OHCA according to arrest aetiology. Methods A state-wide registry identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2023. OHCA was ambulance-defined with cause of OHCA determined by adjudication against autopsy or hospital data. OHCA aetiology was classified into four categories; non-cardiac, coronary, cardiomyopathy or other cardiac (including unascertained cause). Results 2686 patients experienced OHCA (non-cardiac=1305, 48.6%, coronary=585, 21.8%, cardiomyopathy=250, 9.3%, other cardiac=537(282 unascertained), 20.0%), of whom 250 (9.3%) survived. Patients in the coronary group were older (median 45 years [interquartile range 40-48 years], p=0.0001), more likely to be male (83.6%, p&amp;lt;0.0001), have a witnessed arrest (44.6%, p&amp;lt;0.0001) and have an initial shockable rhythm (48.2%, p&amp;lt;0.0001) when compared to other categories. Using the non-cardiac group as the reference group, adjusted odds ratio of survival (95% CI) were 1.65 (0.86-3.19) for cardiomyopathy, 2.51 (1.55-4.07) for other cardiac and 4.03 (2.51-6.49) for coronary causes of OHCA. Conclusion Odds of survival to hospital discharge following OHCA were four times higher in OHCA of coronary aetiology when compared with non-cardiac OHCA. Ongoing research into OHCA according to aetiology is needed to define subgroups, benchmark resuscitation performance more appropriately and identify patterns according to specific aetiologies to improve survival outcomes.

Development and Evaluation of a Rural Longitudinal Neonatal Resuscitation Program Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education).

Neonatal resuscitation is a high-acuity, low-occurrence event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital's interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP) guidelines and teamwork. A TS study was conducted monthly in one rural hospital over a 10-month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts, a neonatologist and a simulation educator. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale. We conducted 10 TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP adherence rate for full code scenarios improved from a baseline of 39 to 95%. Compared with baseline data for efficiency, multiple NRP skills improved (e.g., cardiac lead placement occurred 12× faster, 0:31 seconds vs. 6:21 minutes). Teamwork scores showed improvement in all domains. Our results demonstrate that a TS program aimed at improving NRP and team performance is possible to implement in a rural setting. Our pilot study showed a trend toward improved NRP adherence, increased skill efficiency, and higher-quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes. · Optimal newborn outcomes depend on skillful implementation of NRP.. · Telesimulation can deliver medical education that circumvents challenges in rural areas.. · A longitudinal NRP TS program is possible to implement in a rural setting.. · A rural NRP telesimulation program may improve interprofessional resuscitation performance.. · A rural NRP telesimulation program may improve interprofessional resuscitation teamwork..

Chest Compression Evaluation based on Pose Estimation

Correct and prompt performance of cardiopulmonary resuscitation yields improvements in mortality and social return rates. Chest compression, a vital cardiopulmonary resuscitation technique, requires regular re-education for skill maintenance. Training with a manikin is feasible for chest compression, but assessing proficiencies without an expert presents challenges. This study aims to facilitate autonomous chest compression training even without expert supervision based on pose estimation. Twenty subjects were recruited for the training and successive performance evaluation of chest compression on a sensor-equipped training manikin, and the corresponding videos were recorded simultaneously. A system was developed to analyze chest compression movements through pose estimation on recorded videos for evaluating interruption presence, compression count, compression tempo, compression depth, and compression recoil. Through comparing three pose estimation models, OpenPose demonstrated the best performance, achieving accuracy rates of 67.08%, 56.67%, 61.25%, 39.17%, and 33.75% for the detection of interruption presence, compression count, appropriate tempo count, appropriate depth count, and appropriate recoil count, respectively. Additionally, posture analysis during compression, unattainable with the sensor-equipped manikin, revealed effectiveness in shooting at a position shifted 45 degrees from the front. The proposed method may serve as a tool for completely automated CPR chest compression training, anticipating an increase in citizens proficient in cardiopulmonary resuscitation.

Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

BackgroundSocial determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). MethodsThis cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. ResultsQuery of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. ConclusionsCommunity-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.

How to perform Point of Care Ultrasound at resuscitation and when it is useful.

Point of Care Ultrasound (POCUS) can be useful as a tool before, during and after the performance of cardiopulmonary resuscitation (CPR). Before or after resuscitation it can help with monitoring unstable hemodynamics, has the potential to identify reversible causes if patient deteriorates. During resuscitation POCUS can help detect potentially treatable causes of the cardiac arrest. Performance of POCUS while resuscitation requires experienced sonologists and a good team structure to embed the examination in advanced cardiovascular life support (ACLS) algorithms. This article gives an overview and tips about how to detect potential reversible causes of patient deterioration in all three phases of CPR. We describe some special situations in which resuscitation could take place. Further we give a comment about sonographic education of physicians and nonacademic medical staf.

Improving Cardiopulmonary Resuscitation Quality and Resuscitation Training by Using Real-Time Audiovisual-Assisted Devices.

Context Cardiac arrest occurring outside of a medical facility is a significant cause of death and disability worldwide. In developing nations, it accounts for a notable portion of total mortality, with only a small percentage of those affected surviving beyond the initial emergency department intervention. Despite the critical importance of high-quality cardiopulmonary resuscitation (CPR) in these situations, there has been limited research on the effectiveness of audiovisual feedback devices in improving CPR performance among laypersons or non-medical caregivers. These caregivers, often untrained in advanced medical procedures, play a crucial role in the immediate response to cardiac arrest before professional help arrives. This study aims to address this gap by evaluating the impact of such devices on CPR quality delivered by non-medical individuals. Aim This study aimed to determine whether the use of audiovisual devices would improve cardiopulmonary resuscitation performance among non-medical care providers. Materials and methods Using amultiple-choice questionnaire, an audiovisual aid-based prospective observational study (non-interventional observation study) was conducted at a medical college hospital in Kochi from June 2022 to February 2024. A minimum sample size of 66 was derived from pilot studies, with 95% confidence and 90% power. A total of 146 participants met the inclusion criteria (non-medical personnelof 18-50 years of age). After the exclusion ofpregnant women and non-interested participants, the study participants were analyzed for the quality of cardiopulmonary resuscitation in a mannequin with the help of audiovisual devices.Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, released in 2011). Categorical variables were expressed as frequency and percentage. McNemar's Chi-square test wasapplied to compare the CPR compression rates with and without the visual feedback device, and the kappa statistic was used to assesshow consistently participants performed within the same compression rate category (less than 100, 100-120, or more than 120 compressions per minute) with and without the feedback device. Results The improvement inCPR quality, which was visualized as a green color in the CPR feedback device, was significant, with 109 participants (74.7%) showing good outcomes. The chest compression rate also significantly improved from 95 to 117 with the use of feedback devices (p -0.011, Kappa - 0.167) among non-medical care providers. While the kappa value suggests that some variability exists in compression rates when switching between with and without feedback, the overall improvement is still noteworthy. Conclusion The majority of participants (74.7%) were able to consistently maintaingreen light in the visual feedback watch, which means their chest compression rate was within optimal range (100-120/min) when using the audiovisual feedback device. This indicated that use of audiovisual devicessignificantly improved compression rates among non-medical care providers andeffectively helped them perform high-quality CPR.

Effects of Concurrent Training on Resuscitation and Cognitive Performance in Paramedics-A Pilot Study.

Paramedics work under physically and cognitively demanding conditions to provide emergency care. As physical fitness could positively impact the quality of patient care, we investigated within a pilot study whether concurrent training (CT) affects work-related performance parameters in paramedics. At baseline (T1), 16 paramedics performed cardiopulmonary resuscitation whereby resuscitation performance (RP; total resuscitation quality, compressions with correct frequency, and correct ventilation), cognitive performance (CP; reaction time, divided attention, and working memory), and heart rate variability (HRV) were assessed (pre-exertion). Then, participants climbed seven floors carrying 20 kg of gear before completing the same assessments again (post-exertion). The baseline testing was followed by a CT intervention (12 weeks, three sessions/week). After the intervention (T2), the two-stage testing was repeated. We analyzed whether the pre-exertion and post-exertion values, as well as the difference between the pre-exertion and post-exertion values, changed from T1 to T2. Nine paramedics (male: N = 7; age = 26.3 (SD = 8.17) years) took part in the study. The comparison of the pre-exertion values showed significantly better reaction times (p = 0.001) and divided attention (p = 0.02) and a trend toward greater working memory and RP parameters at T2. Regarding the post-exertion values, significant improvements in working memory (p = 0.03) and a trend toward improved reaction time, divided attention, and RP occurred at T2. The difference between the pre- and post-exertion values did not change for any parameter from T1 to T2. HRV decreased significantly from pre- to post-exertion (T1: p = 0.01, T2: p = 0.01). These results indicate that CT is a promising training concept to improve RP and CP in paramedics and should therefore be investigated further to increase patient care quality.

Changing the Culture to Improve CCF: An Improvement Project

Objectives After identifying chest compression fraction (CCF) as a key area for improvement, our Emergency Medical Services (EMS) agency aimed to improve our baseline monthly median CCF from 81.5% to 90% or more in paramedic-attended medical cardiac arrests by December 2023. The CCF is a process measure that, if improved, has been shown to increase likelihood of survival from cardiac arrest. Working as a hospital EMS agency within a large urban 9-1-1 system, our interventions focused on paramedics once they arrived on scene. Methods This project used repeated Plan-Do-Study-Act (PDSA) cycles with brainstorming sessions, focus groups, and data review to achieve improvement. Interventions included standardized clinician feedback forms, increased follow-up for patients with ongoing resuscitation, a designated CPR team leader during resuscitations, and a pre-charged defibrillator prior to rhythm checks. These interventions were evaluated by tabulating weekly and monthly median CCF performance, seeking participant feedback, and reviewing control charts. These results were reported according to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0). Results Our control chart analysis revealed special cause variation and an increase in average CCF to 89.0%. This improvement was achieved through successful implementation of process changes using PDSA cycles. Our most effective and popular intervention was our clinician feedback forms. Additionally, re-unifying patients and their successful resuscitation teams, participating in resuscitation academy events, and pre-charging the defibrillator to minimize CPR pauses collectively resulted in systemic improvement in resuscitation performance. Conclusions The findings illustrate that targeted education, increased clinician feedback, patient-team reunification, and high-performance resuscitation strategies produce measurable improvement in CCF.

Compliance of cardiopulmonary resuscitation during in hospital cardiac arrest in a teaching institution

Background: Cardiopulmonary resuscitation (CPR), the essential part of emergency care, is defined as chest compressions and ventilation for survival of cardiac arrest patients, which indicates the influence of outcome and exerts a significant survival benefit after cardiac arrest. Aims: The primary objective of this audit is to determine compliance with the American Heart Association 2020 guidelines by measuring multiple parameters of in hospital CPR quality. Settings and Design: In hospital cardiac arrest (IHCA) patients from all wards of a tertiary care medical college institution was selected for this observational analytic study between January 1, 2019 and December 31, 2021. Materials and Methods: Our study was conducted without randomization, blinding, or control groups, in all code blue victims aged between 20 and 80 years, who suffered cardiac arrest. The results of the compliance of CPR during IHCA in a teaching institution are discussed based on the CPR audit findings under the quality indicators such as protocol deviations, documentation issues, and resource issues. Statistical Analysis: Evaluation, analysis, compilation, and statistical reporting were done on documentation based on these quality indicators. Results and Conclusions: Over a three-year period, 672 cardiac arrest victims analyzed. Of these, 30.91% demonstrated protocol deviation compliance, 15.97% had documentation issues, 12.27% had resource issues, and 40.85% had excellent documentation with no errors or corrections in the critical event monitoring. Out of 672 victims, only 15.62% of cardiac arrest patients achieved spontaneous circulation. The patients who had shockable initial rhythm on the monitor had better outcomes than those who did not have shockable rhythm. Our study revealed that the issues with resuscitation performance in an algorithmic approach were more significant than those with documentation and resource issues. The quality of CPR performance can be improved by demonstrating live and practicing on a mannequin with appropriate teamwork and knowledge sharing.

A Randomized Controlled Simulation Trial of a Neonatal Resuscitation Digital Game Simulator for Labour and Delivery Room Staff.

Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants' neonatal resuscitation knowledge. In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20-30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention.

Newborn resuscitation practices among nurses and midwives in Ghana

BackgroundNewborn resuscitation is critical for reducing mortality and morbidity among neonates with intrapartum complications such as birth asphyxia. Nurses and midwives are at the forefront of caring for newborns with birth asphyxia. Their behaviour, therefore, toward newborn resuscitation is critical to the newborn's survival. PurposeThe focus of this study is to investigate the factors that influence the performance of newborn resuscitation practices among nurses and midwives in the clinical setting. Designand methods: A qualitative explorative, descriptive design was used with a purposive sampling technique to recruit a sample of Seventeen (17) nurses and midwives from two hospitals, in the Eastern Region of Ghana. Face-to-face interviews, using a semi-structured interview guide were employed for data collection. Thematic analysis was used to analyse the data. FindingsThe findings showed that good knowledge and understanding of newborn resuscitation had a positive impact on the attitude and behaviour of nurses and midwives. Again, people of referents and the family, including culture and religion, had a great influence on the performance of newborn resuscitation. ConclusionFactors such as lack of training, shortage of human and material resources, inadequate space, poor supervision, and monitoring were identified as direct and indirect barriers to newborn resuscitation performance among the nurses and midwives in the context of Ghana. Practice implicationsWe recommend stakeholders and policymakers institute regular training, inculcating family-centered care in training, monitoring, and provision of the necessary amenities needed for effective newborn resuscitation to help improve the nurse or midwife's behaviours towards their practice.

Basic life support training for intensive care unit nurses at a general hospital in Tabriz, Iran: a best practice implementation project

ABSTRACT Introduction and objectives: Basic life support (BLS) is foundational to the care delivered to cardiac arrest victims. This study evaluated current practices and implemented best practices related to BLS training for intensive care unit (ICU) nurses in a general hospital in Tabriz, Iran. Methods: This interventional before-after study was informed by the JBI Evidence Implementation Framework. An audit, feedback, and re-audit strategy was used to measure baseline compliance with best practices, develop an implementation strategy to address gaps in compliance, and undertake a final evaluation to measure changes in compliance. The JBI Practical Application of Clinical Evidence System (JBI PACES) and situational analysis Getting Research into Practice (GRiP) tool were used to support data collection and implementation planning. There were 13 evidence-based criteria and a sample of 9 ICU nurses. Results: The baseline audit revealed gaps between current practice and best practice in 9 of the 13 criteria. Barriers included insufficient education tools and programs, insufficient supervision, lack of skills laboratories, and a lack of continuous BLS education. Improvement strategies included providing a human stimulator manikin, developing an education program for nurses, as well as establishing a cardiopulmonary-cerebral resuscitation department, a skills laboratory, and continuous BLS education based on the American Heart Association guidelines. The follow-up audit revealed improvement of 100% across all criteria. Conclusions: This project indicates that a clinical audit is effective for assessing evidence-based BLS education for ICU nurses, thereby improving resuscitation performance and patient outcomes. Spanish abstract: http://links.lww.com/IJEBH/A213

Assessment of dispatch-assisted cardiopulmonary resuscitation performance during out-of- hospital cardiac arrest in a Tuscan emergency operation center: a retrospective study

Background: Time is the most crucial prognostic factor in out-of-hospital cardiac arrest (OHCA) owing to its clinical features. Dispatcher-assisted CPR (DA-CPR) by dispatch centers to a bystander calling for an ambulance, enabling even an inexperienced bystander to start CPR in 50% of cases and reducing the free therapy interval from chest compression to less than three minutes. Objectives: to assess the dispatch-assisted cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest. Methods: a retrospective study was conducted at the Firenze-Prato Emergency Operation Centre to analyse data collected from all dispatch audio recordings of OHCA events that occurred between 1 January 2019 and 31 December 2020. Emergency calls lasting less than 60 s were excluded from the analysis, as this duration does not provide dispatchers with adequate time to accurately identify OHCA and provide pre-arrival instructions to the bystander.Results: A total of 1,267 OHCAs cases were included in this study, with 832 (65.7%) occurring in 2019 and 435 (34.3%) in 2020. Emergency nurses offered pre-arrival instructions in 272 cases (21.5%), with 160 cases in 2019 (19.2%) and 112 cases (25.7%) in 2020 (c2=7.19, p=0.007). These instructions were accepted by the caller in 9% (n=75) and 14% (n=61) of the cases, respectively (c2=7.48, p=0.006). OHCA events that could not be identified by telephone (therefore, DA-CPR was not possible) were 365 cases (43.9%) in 2019 and 175 cases (40.2%) in 2020 (c2=1.55, p=0.213). Conclusions: The adoption of a standardised protocol for delivering pre-arrival instructions, along with training programs focusing on OHCA and interview techniques, is strongly recommended based on the findings of our study. This was reinforced by the analysis of nighttime calls during which DA-CPR was not provided, including cases without clear justification.