Cardiopulmonary Resuscitation Research Articles

CPR training as a gender and rights-based healthcare issue.

It is not understood how cardiopulmonary resuscitation (CPR) training, specifically the representation of sex in CPR manikins, contributes to inequitable outcomes in cardiac arrest survival. The aim of this study was to identify the sex and chest wall secondary sexual characteristics of CPR manikins on the global market. The secondary aim was to identify if manikin manufacturing companies had a publicly available sustainability policy or equivalent, and if these covered products were manufactured. We conducted an observational descriptive study of the secondary sex characteristics and named sex of CPR training manikins available on the global market, and equity, diversity and inclusion (EDI), human rights and sustainability policies of the companies that manufacture them. Nine CPR manikin manufacturers were identified. Twenty CPR manikins were included for analysis. Of the 20 manikins, 75% were identified as male (n = 8, 40%) or no gender specified (n = 7, 35%) and all these had flat torsos-one had a breast overlay available. One company had a 2020 sustainability report that addressed EDI for the workforce only, and a 2023 report addresses this for products manufactured. Adult CPR manikins available globally are largely homogenous, flat-chested and do not have secondary sex characteristics or a named sex. One company had a sustainability report that referenced workforce only and has since committed to EDI for products manufactured. We urge CPR training providers and manufacturers to collectively promote a rights-based approach to healthcare aligned with the commercial determinants of health by committing to improving the diversity of CPR training manikins.

Cardiopulmonary resuscitation employing only abdominal compressions in infants after cardiac surgery: A secondary sub-analysis of the ICU-RESUS study

ImportancePatients with underlying cardiac disease form a considerable proportion of pediatric patients who experience in-hospital cardiac arrest. In pediatric patients after cardiac surgery, CPR with abdominal compressions alone (AC-CPR) may provide an alternative to standard chest compression CPR (S-CPR) with additional procedural and physiologic advantages. ObjectiveQuantitatively describe hemodynamics during cardiopulmonary resuscitation (CPR) and outcomes of infants who received only abdominal compressions (AC-CPR). DesignThis is a sub-group analysis of the prospective, observational cohort from the ICU-RESUS trial NCT028374497. Setting & PatientsA single site quaternary care pediatric cardiothoracic intensive care unit enrolled in the ICU-RESUS trial. Patients less than 1 year of age with congenital heart disease who required compressions during cardiac arrest. InterventionsUse of AC-CPR during cardiac arrest resuscitation. Measurements and Main ResultsInvasive arterial line waveforms during CPR were analyzed for 11 patients (10 surgical cardiac and 1 medical cardiac). Median weight was 3.3 kg [IQR 3.0, 4.0]; and median duration of CPR was 5.0 [3.0, 20.0] minutes. Systolic (median 57 [IQR 48, 65] mmHg) and diastolic (median 32 [IQR 24, 43] mmHg) blood pressures were achieved with a median rate of 114 [IQR 100, 124] compressions per minute. Return of spontaneous circulation was obtained in 9 of 11 (82%) patients; 2 patients (18%) were cannulated for extracorporeal cardiopulmonary resuscitation (ECPR) and 6 (55%) survived to hospital discharge with favorable neurologic outcome. ConclusionsAC-CPR may offer an alternative method to maintain perfusion for infants who experience cardiac arrest. This may have particular benefit in pediatric patients after cardiac surgery for whom external chest compressions may be harmful due to anatomic and physiologic considerations.

Intra-aortic balloon pump synchronized with chest compressions improves outcome during cardiopulmonary resuscitation in experimental cardiac arrest

BackgroundIntra-aortic balloon pump (IABP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) are two endovascular intervention methods for circulatory support. The aim of this study was to compare the hemodynamic effects of simultaneous mechanical chest compressions (MCC) with IABP, REBOA and those with only MCC (overall and detailed in the MCC cycle) and return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) in experimental non-traumatic cardiac arrests (CA). MethodCA was electrically induced (ventricular fibrillation) in 24 anesthetized pigs, which then were randomized to MCC synchronized IABP (n = 8), total occluded REBOA (n = 8), or control (n = 8). After 10 min of CA, CPR with MCC was started followed by one of the interventions after one minute of CPR. Every other minute after MCC start, the pigs were defibrillated with 200 J if VF/ventricular tachycardia, and after six minutes, adrenaline was administered and repeated every four minutes. The proportions of ROSC were calculated. Hemodynamic variables, including systemic blood and coronary perfusion pressures (CPP), and carotid and iliac blood flows, were collected and analyzed with 0.02 s resolution. ResultsIn both the IABP and REBOA groups, 7 of 8 animals (87.5 %) achieved ROSC, in contrast with 2 of 8 (25 %) in the control group (P = 0.04). IABP and REBOA significantly increased systemic arterial pressure (P = 0.002 and P = 0.015, respectively), and REBOA also increased CPP and carotid blood flow when compared to controls (P = 0.007 and P = 0.03, respectively). Animals with IABP had a preserved blood flow in the iliac artery during CPR. No differences were detected after ROSC in hemodynamic, metabolic, and organ injury variables between the REBOA and IABP groups. ConclusionBoth IABP and REBOA increased the proportion of ROSC compared to controls. However, REBOA occluded distal blood flow, while IABP maintained it. This study suggests that MCC synchronized IABP could be an adjunct in the treatment of non-traumatic CA.

Kids save lives: Who should train schoolchildren in resuscitation? A systematic review

AimCPR training for schoolchildren to increase bystander CPR-rates is widely applied. HCPs are regarded as the instructor gold standard, but using non-HCP instructors (e.g., peer-tutors, schoolteachers, medical students) challenges that. This systematic review assesses whether cardiopulmonary resuscitation (CPR) training for children led by peer-tutors, schoolteachers, or medical students results in different learning outcomes to training by health-care professionals (HCPs). MethodsWe searched studies that compared CPR training for schoolchildren (population) delivered by peer-tutors, schoolteachers, or medical students (intervention), with training led by HCPs (comparison), assessing student knowledge, skills, willingness and/or confidence to perform CPR (outcome). We included randomized and non-randomized controlled trials (study design). Medline, Embase, Psychinfo, Cinahl, Cochrane, Scopus, Web of Science, and Eric were searched from inception until December 23rd, 2023 (timeframe). Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. We followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines, and registered the review with PROSPERO. ResultsOf 9′092 studies identified, 14 were included. Comparison of intervention groups to HCP-led training showed similar overall results (knowledge, skills, self-confidence). Superior results for HCP training were only reported for ‘ventilation volume’, while schoolteachers and medical students achieved superior knowledge transfer. A meta-analysis was possible for ‘compression depth’ between peer-tutors and HCPs showing no significant differences. Certainty of evidence was ‘low’ to ‘very low’. ConclusionThis systematic review of CPR training for school children revealed that peer-tutors, schoolteachers and medical students achieve similar educational outcomes compared to those of HCPs. Non-HCPs training schoolchildren is an appropriate cost-efficient alternative and easy to implement in school curricula.

Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study

Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study

Declining Trend of Sudden Cardiac Death in Younger Individuals: A 20-Year Nationwide Study.

Declining cardiovascular mortality rates have been well-documented, yet temporal trends of sudden cardiac death (SCD) in young individuals remain unclear. We provide contemporary nationwide estimates of the temporal trends of SCD in young individuals (1-35 years of age) from 2000 through 2019 and correlate these trends to changes in out-of-hospital cardiac arrest (OHCA) patterns, rates of inherited cardiac diseases, and implantations of implantable cardioverter defibrillators (ICD). All individuals between 1 and 35 years of age living in Denmark from 2000 through 2019 were included, with annual re-evaluation of the at-risk population in regard to age. Adjudication of SCD cases relied on multiple sources, including death certificates, medical files, and autopsy reports. Information on OHCA, diagnostic rates, and ICD implantations were captured from nationwide administrative registries. Annual incidence rates of SCD were calculated, and temporal trends in SCD incidence were computed as percentage change annualized. Trends in OHCA survival and characteristics, diagnostic rates of inherited cardiac diseases, and ICD implantations were assessed. During the 20-year study period (47.5 million person-years), 1057 SCDs were identified (median age, 29 years; 69% male). The overall incidence of SCD was 2.2 per 100 000 person-years and declined by 3.31% (95% CI, 2.42-4.20) annually, corresponding to a 49% (95% CI, 38.7-57.6) reduction during the study. Rates of witnessed SCD declined markedly (percentage change annualized -7.03% [95% CI, -8.57 to -5.48]), but we observed no changes in the rate of unwitnessed SCD (percentage change annualized -0.09% [95% CI, -1.48 to 1.31]). Therefore, the proportion of unwitnessed SCD increased by 79% (P<0.001). Survival after OHCA in young individuals (1 to 35 years of age) increased from 3.9% to 28%, mainly because of increased bystander cardiopulmonary resuscitation and defibrillation rates. Diagnostic rates of inherited cardiac diseases increased 10-fold (incidence rate ratio, 10.4 [95% CI, 8.46-12.90]) and the ICD implantation rate increased 2-fold (incidence rate ratio, 1.97 [95% CI, 1.51-2.60]). SCD incidence rates in young individuals declined by 49% over the past 2 decades. The decline was paralleled by improved survival of OHCA, higher diagnostic rates of inherited cardiac diseases, and higher ICD implantation rates. However, rates of unwitnessed SCD were unchanged, which calls for new perspectives in preventive strategies.

PRECORDIAL THUMP AS A LIFE-SAVING RESUSCITATION MEASURE IN OBESE PATIENTS DURING OUT-OF-HOSPITAL CARDIAC ARREST

Introduction: The precordial thump (PT) was until recently recognized as a life-saving measure for confirmed and monitored shockable rhythm cardiac arrest (CA) cases when a defibrillator is not immediately vailable, but cardiopulmonary resuscitation guidelines no longer mention it. Objectives: We present the PT as a life-saving measure during CA in obese patient. Case report: The emergency medical team intervened on a 69-year-old man, with, complaining of chest pain lasting &gt;1h. He was dyspneic, pale and clammy skin. RR 18/min, SatO2 89%, HR 76 bpm, BP of 80/50 mmHg. ECG: anterior ST elevation myocardial infarction with right bundle branch block. He was allergic to aspirin. He was treated with 180mg of oral ticagrelor, a 500ml saline solution IV and 4 l/min O2 by mask and then went into CA. Before the defibrillator became available, patient was treated with three PTs, an oropharyngeal airway placement, bag valve mask ventilation with 100% oxygen and the initiation of chest compressions. When the biphasic defibrillator arrived, the monitor showed coarse ventricular fibrillation. One DC shock with 200J of energy was delivered. After the shock, the patient regained consciousness, a pulse and spontaneous breathing. The ECG monitor showed a sinus rhythm of 143 bpm, BP 80/50 mmHg, and SatO2 89%. Conclusion: Although CPR guidelines no longer mention the PT, the question remains whether it could be an initial life-saving procedure during CA in obese patients.

Case Report: Sudden death caused by methylene chloride poisoning

Dichloromethane is widely used as an organic solvent in aerospace, electronics, and medicine. Cases of poisoning caused by this substance are rare. Recently, we successfully treated a patient with an acute dichloromethane poisoning. During the production process, owing to pipeline leakage and lack of personal protection, the patient was poisoned by dichloromethane inhalation, fell from a height, and experienced a sudden cardiac arrest. After successful cardiopulmonary resuscitation, the patient was transferred to a local hospital for diagnosis and treatment and then to our hospital. After two visits to our hospital for systematic diagnosis and active treatment with fluid infusion, anti-infection therapy, glucocorticoids, ventilator-assisted respiration, chest strap fixation, and nutritional support, the patient achieved clinical recovery.

Deep learning-based Emergency Department In-hospital Cardiac Arrest Score (Deep EDICAS) for early prediction of cardiac arrest and cardiopulmonary resuscitation in the emergency department

BackgroundTimely identification of deteriorating patients is crucial to prevent the progression to cardiac arrest. However, current methods predicting emergency department cardiac arrest are primarily static, rule-based with limited precision and cannot accommodate time-series data. Deep learning has the potential to continuously update data and provide more precise predictions throughout the emergency department stay.MethodsWe developed and internally validated a deep learning-based scoring system, the Deep EDICAS for early prediction of cardiac arrest and a subset of arrest, cardiopulmonary resuscitation (CPR), in the emergency department. Our proposed model effectively integrates tabular and time series data to enhance predictive accuracy. To address data imbalance and bolster early prediction capabilities, we implemented data augmentation techniques.ResultsOur system achieved an AUPRC of 0.5178 and an AUROC of 0.9388 on on data from the National Taiwan University Hospital. For early prediction, our system achieved an AUPRC of 0.2798 and an AUROC of 0.9046, demonstrating superiority over other early warning scores. Moerover, Deep EDICAS offers interpretability through feature importance analysis.ConclusionOur study demonstrates the effectiveness of deep learning in predicting cardiac arrest in emergency department. Despite the higher clinical value associated with detecting patients requiring CPR, there is a scarcity of literature utilizing deep learning in CPR detection tasks. Therefore, this study embarks on an initial exploration into the task of CPR detection.

Rapid oxygen titration following cardiopulmonary resuscitation mitigates cerebral overperfusion and striatal mitochondrial dysfunction in asphyxiated newborn lambs.

Asphyxiated neonates must have oxygenation rapidly restored to limit ongoing hypoxic-ischemic injury. However, the effects of transient hyperoxia after return of spontaneous circulation (ROSC) are poorly understood. We randomly allocated acutely asphyxiated, near-term lambs to cardiopulmonary resuscitation in 100% oxygen ("standard oxygen", n = 8) or air (n = 7) until 5 minutes after ROSC, or to resuscitation in 100% oxygen immediately weaned to air upon ROSC ("rapid-wean", n = 7). From 5 minutes post-ROSC, oxygen was titrated to target preductal oxygen saturation between 90-95%. Cerebral tissue oxygenation was transiently but markedly elevated following ROSC in the standard oxygen group compared to the air and rapid-wean groups. The air group had a delayed rise in cerebral tissue oxygenation from 5 minutes after ROSC coincident with up-titration of oxygen. These alterations in oxygen kinetics corresponded with similar overshoots in cerebral perfusion (pressure and flow), indicating a physiological mechanism. Transient cerebral tissue hyperoxia in the standard oxygen and air groups resulted in significant alterations in mitochondrial respiration and dynamics, relative to the rapid-wean group. Overall, rapid-wean of oxygen following ROSC preserved striatal mitochondrial respiratory function and reduced the expression of genes involved in free radical generation and apoptosis, suggesting a potential therapeutic strategy to limit cerebral reperfusion injury.

Impact of visual distraction on neonatal mask ventilation: a simulation-based eye-tracking study

ObjectiveThis study aimed to investigate whether distractions during simulated neonatal resuscitation impact mask leakage and visual gaze patterns during positive pressure ventilation (PPV) of a newborn manikin.Study designIn this observational,...

Characteristics of helicopter hoist operations with intubated patients: a retrospective analysis of a Norwegian physician staffed SAR helicopter service

BackgroundTimely medical management and evacuation of critically ill or injured patients from austere environments or maritime vessels is often achieved by helicopter hoist operations. When indicated, intubation is performed onsite to restore and sustain patient physiology and to facilitate safe transport. We aimed to describe the characteristics of helicopter hoist operations (HHOs) with intubated patients in a physician staffed SAR helicopter service and to identify learning points for future missions.MethodsThe Norwegian national SAR database and local medical journal systems on six SAR helicopter bases were searched for data on hoisted intubated patients from January 2011 to April 2024.ResultsFrom a total of 18,710 missions, we registered 2,423 helicopter hoist operations with patients as human external cargo. In 54 hoist operations (2%) the patients were intubated prior to hoisting. We observed an increasing number of both HHOs in general and HHOs with intubated patients over time. The intubated HHO patients were in an overall critical state, with a median NACA score of 6 and a median GCS of 3 before intubation. Trauma was the main cause of intubation (n = 32). Twenty-five patients presented with cardiac arrest, 13 of whom were hoisted with an ongoing mechanical chest compression device. During the hoist operation, 34 patients were ventilated manually, and 20 patients were connected to an automatic ventilator. Monitoring of vital parameters during hoisting varied from none to fully monitored patients including invasive arterial blood pressure. Twenty-eight patients, seven of whom presented with initial cardiac arrest, survived to hospital discharge.ConclusionsHHOs with intubated patients are rare but increasingly occurring events in our service. Owing to the infrequency, complexity and risk factors involved, these operations should be governed by specific operating procedures and trained regularly to be performed safely. HHOs with intubated patients represents a favourable alternative in situations where terrestrial transport is associated with significant time delay or additional risk to the patient or the rescuers.

Perspectives on cardiopulmonary resuscitation in the frail population: a scoping review.

Frail and elderly persons approaching end of life who suffer cardiac arrest are often subject to rigorous, undignified, and inappropriate resuscitation attempts despite poor outcomes. This scoping review aims to investigate how people feel about the appropriateness of CPR in this population. This review was guided by the PRISMA-ScR methodological framework. A search strategy was developed for four online databases (MEDLINE, EMCARE, PSYCHINFO, CINAHL). Two reviewers were utilised for title/abstract screening, full text review and data extraction. Full text, peer reviewed studies were eligible for inclusion which discussed perspectives in the frail and/or elderly population with a focus on cardiopulmonary resuscitation (CPR). The database search yielded 3693 references (MEDLINE n = 1417, EMCARE n = 1505, PSYCHINFO n = 13, CINAHL n = 758). Following removal of duplicates (n = 953), title and abstract screening was performed on 2740 papers. A total of 2634 articles did not meet the inclusion criteria. Twenty-five studies were included in the scoping review and analysed for data extraction. Five themes emerged: (i) Preferences towards CPR, (ii) Preferences against CPR, (iii) Poor knowledge of CPR/Estimated survival rates, (iv) Do Not Resuscitate Orders, and (v) Decisional authority. This scoping review maps and describes the common perspectives shared by CPR stakeholders in the frail/elderly population. Findings revealed CPR decisions are often made based on incorrect knowledge, DNAR orders are frequently underused, CPR decisional authority remains vague and healthcare professionals have mixed views on the appropriateness of CPR in this population.

Racial disparities in the frequency and timing of code status orders among women with breast cancer

BackgroundBlack/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in this vulnerable patient population. Code status orders (i.e., Full code, Do Not Attempt Resuscitation [DNAR], Do Not Intubate [DNI]) allow consideration of patient preferences regarding the use of aggressive treatments, such as cardiopulmonary resuscitation and intubation. The aim of this study is to characterize presence of code status orders and determine whether race affects code status documentation after the first encounter for breast cancer.MethodsData were derived from 7524 women with breast cancer from the University of Chicago Medical Center (UCMC) between 2016 and 2021. Cox regression was used to estimate the effects of race and adjusted for age, ethnicity, inpatient stays, metastatic breast cancer, marital status, and body mass index.ResultsThe sample included 60.5% White, 3.6% Asian/Mideast Indian, 28.9% Black/African American, and 7.0% other or unknown race. Results indicate that code status orders after the first breast cancer encounter were uncommon (7.2%). Black/African American race (HR = 2.74; 95% CI: 1.75, 4.28) emerged as a significant factor associated with any code status orders compared to other race groups even when adjusting for covariates.ConclusionsCode status documentation in this sample of women with breast cancer was low overall, yet rates were higher among Black/African American patients compared to other race groups. In fact, race remains a significant predictor of code status documentation even when accounting for indirect measures of cancer severity. This could be denoting the racial disparities (e.g., higher cancer malignancy such as triple negative breast cancer) in breast cancer mortality risk. Future research is needed to identify factors unique to Black/African American women that would increase code status documentation so that goal concordant care can be prioritized among patients with breast cancer.

Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart Disease: Single-Center, Retrospective Cohort Study, 2014-2022.

Pediatric patients with advanced heart disease (AHD) often receive high intensity medical care at the end of life (EOL). In this study, we aimed to determine whether receipt and timing of pediatric palliative care (PPC) consultation was associated with EOL care intensity of pediatric patients with AHD. Retrospective cohort study. Single-center, 16-bed cardiac ICU (CICU) in a children's hospital in the Mountain West. Pediatric patients (0-21 yr) with AHD treated in the CICU and subsequently died from January 2014 to December 2022. None. We compared demographics, EOL characteristics and care, including medical interventions and mortality characteristics for patients by receipt and timing of PPC (i.e., ≥ 30 d from [early] or < 30 d of death [late]) using chi-square and Wilcoxon rank-sum tests. Of 218 patients, 78 (36%) did not receive PPC, 76 received early PPC (35%), and 64 received late PPC (29%). Compared with patients who did not receive PPC, patients receiving PPC had lower EOL care intensity (77% vs. 96%; p = 0.004) and fewer invasive interventions within 14 days of death (74% vs. 92%; p = 0.004). Receipt of PPC, vs. not, was associated with lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p = 0.004) and more use of comfort care (23% vs. 3%; p = 0.004). Among patients receiving PPC, early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p = 0.033). Care intensity was high for patients with early and late PPC. Early PPC was associated with fewer invasive interventions within 14 days of death, yet the care intensity at EOL remained high. With early PPC, families likely receive timely psychosocial and advance care planning support without significantly altering goals of care.

Ethical issues in termination of resuscitation decision-making: an interview study with paramedics and relatives of out-of-hospital cardiac arrest non-survivors

BackgroundIn out-of-hospital cardiac arrest (OHCA), decisions to terminate resuscitation or transport the patient to hospital are ethically fraught. However, little is known about paramedics’ ethical concerns in these decision-making processes.ObjectiveTo...

Cross-cultural adaptation and validation of the Spanish version of the Cardiopulmonary Resuscitation Motivation Scale (s-CPRMS): a cross sectional study

BackgroundCardiac arrest remains a serious global health issue worldwide which claims for review and improvement. High motivation among resuscitators could lead to high-quality resuscitation and better outcomes. This study aimed to translate and cross-culturally adapt the Cardiopulmonary Resuscitation Motivation Scale into Spanish and assess the psychometric properties of the Spanish version (s-CPRMS).MethodsA sample of critical care and acuity-emergency physicians and nurses (N = 352) participated in an observational cross-sectional study structured in 3 phases.ResultsFace and content validity was confirmed for the s-CPRMS (s-CVI = 0.88). The ordinal alpha was 0.847, ranging from 0.796 to 0.92 for the factors, indicating good reliability and temporal stability (mean ICC = 0.701; p < 0.001). The Exploratory Factor Analysis (EFA) results showed the s-CPRMS was distributed into four factors that explained 58% of the variance with values of the goodness of fit indices indicating an adequate fit for the model extracted in the Confirmatory Factor Analysis (CFA): χ2 (246) = 402.240; p < 0.001, SRMR = 0.086, RMSEA = 0.059, TLI = 0.965, CFI = 0.969, GFI = 0.990.ConclusionsThe s-CPRMS is a valid and reliable instrument to assess the motivation of resuscitation teams, which might lead to potential effective strategies to resuscitation quality improvement and outcomes.

Positional asphyxia: Potpourri of cases

A legal medicine specialist will likely be able to observe a variety of situations in which positional asphyxia, a deadly condition resulting from the adoption of specific body positions that cause mechanical interference with pulmonary ventilation, can occur (work, car accidents, torture, kidnapping, etc.). In these circumstances the cause of death is typically difficult to determine because the patient typically presents with a distinct anatomo-pathologic appearance.Because of chest compression, positional asphyxia can occasionally be difficult to differentiate from asphyxia. The primary distinction is in how the incident happened: that is, if the specific posture that resulted in asphyxia was acquired voluntarily or was due to an external mechanical action that led to traumatic asphyxia.Three basic criteria are used to diagnose positional asphyxia: the body posture must impede normal gas exchange , moving to a different position must be impossible, and alternative cause of natural or violent death must be ruled out. The authors here present a series of five cases drawn from the professional experience to highlight the primary patho-physiologic and diagnostic causes of positional asphyxia.

2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Thoracic Responses and Injuries of Male Post-Mortem Human Subjects in a Homogeneous Rear-Facing Seat During High-Speed Frontal Impact.

In recent post-mortem human subjects (PMHS) studies in a high-speed rear-facing frontal impact (HSRFFI), the PMHS sustained multiple rib fractures. The seatback structure and properties of the seats might contribute to these fractures. This study aimed to determine if a homogeneous rear-facing seat with foam-covered seatback would mitigate the risk of thoracic injury during an HSRFFI. Three male PMHS were subjected to the same previous HSRFFI pulse. The seating structure consisted of a homogeneous seatback composed of rigid plates with load cells and covered with both comfort and safety foam. The PMHS spine was instrumented with accelerometers and angular rate sensors. Two chestbands were attached at the level of the axilla and xiphoid, and strain gages and strain rosettes were attached to ribs. Whole-body kinematics were quantified using a motion capture system. PMHS1 and PMHS3 sustained 30 and 13 rib fractures, respectively, while PMHS2 did not sustain any fractures. Average maximum anterior-posterior (A-P) chest compressions ranged from 15.9 to 22.6%. Rib fractures occurred before and after the maximum A-P compression, so A-P chest compression alone did not correlate well with rib fracture outcomes. Thoracic inferior-superior (I-S) deformation relative to the T12 was 107.4mm for PMHS1, 27.6mm for PMHS2, and 85.1mm for PMHS3. The direction of the maximum principal strain indicated that ribs experienced shear caused by I-S chest deformation. These results will assist with the development of countermeasures to protect occupants in a rear-facing seating configuration, along with validation of human body models.