Resuscitation Techniques Research Articles

Knowledge and Attitude regarding Cardio Pulmonary Resuscitation (CPR) among Nurses in Bangladesh

Cardiac arrest remains a leading cause of mortality worldwide. The effective management of cardiac arrest requires a thorough understanding of cardiopulmonary resuscitation (CPR) techniques. As frontline healthcare providers, nurses are pivotal in identifying cardiac arrest and initiating CPR. This study aimed to evaluate the level of knowledge and attitude regarding CPR among nurses at Chittagong Medical College Hospital (CMCH), Bangladesh. A descriptive cross-sectional study was conducted involving government-registered nurses employed at CMCH. A convenience sampling method was employed to select participants. Data were collected using self-administered semi-structured questionnaires. The study found that 68.1% of the nurses had a diploma in nursing and limited experience in CCU/ICU and emergency departments. Furthermore, 76% of the nurses had not received CPR training. Only 1.4% of the participants exhibited good knowledge of CPR, 37.2% had an average level of knowledge, and 61.5% demonstrated poor knowledge. Regarding attitudes towards CPR, 24% of the nurses had a good attitude, while 76% had an average attitude. The findings indicate that nurses at CMCH possess inadequate knowledge of CPR despite a moderate attitude towards its practice. This study provides foundational data that could guide efforts to enhance CPR training and knowledge among nurses in Bangladesh.

The effect of peer tutoring on pediatric nursing education: a systematic review.

This study aimed to systematically review studies on the effect of peer tutoring on pediatric nursing education for nursing students and identify its contents and characteristics. A comprehensive search was conducted from November to December 2023 across databases including PubMed, Embase, CENTRAL, CINAHL, ProQuest, and others. We included both published and unpublished literature in English or Korean. Three reviewers independently screened and selected eligible studies that involved undergraduate nursing students participating in peer tutoring programs focused on pediatric nursing education. We analyzed quantitative outcomes related to learning effects and learner responses. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials and the risk of bias assessment tool for non-randomized studies. Five studies were reviewed, encompassing randomized controlled trials, a non-randomized controlled trial, a cohort study, and a before-after study. These interventions were conducted in school settings or pediatric clinical environments and featured different forms of peer teaching: horizontal, near-peer, and reciprocal. The tutor-to-tutee ratios ranged from 1:3 to 1:36.5. The educational content covered nursing care for major neonatal diseases, communication skills, medication administration, and resuscitation techniques. Significant improvements in cognitive knowledge and communication skills were observed among nursing students. However, there was noticeable variability in the design and reporting of the studies. Peer tutoring programs can effectively enhance pediatric nursing education by improving nursing students' knowledge and skills. For future meta-analyses, more studies in this field reported according to reporting guidelines are needed.

Complete genome sequence of the saprophytic actinomycete Prescottella soli DSD51WT, closely related to the multi-host pathogen Prescottella (Rhodococcus) equi.

Prescottella soli strain DSD51WT is an aerobic, non-spore-forming, non-motile actinomycete isolated previously from soil collected from Kyoto Park, Japan, using a resuscitative technique. Here, we report the complete, circular genome sequence of P. soli DSD51WT. We employed a hybrid approach using Illumina and Oxford Nanopore platforms.

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.

Spontaneous Umbilical Cord Vascular Rupture during Labor: A Retrospective Analysis of 12 Cases.

Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition. This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023. The inclusion criteria included gestational age of ≥28 weeks, occurrence during labor, and availability of complete delivery data. Data on fetal heart rate (FHR) changes, delivery intervals, intraoperative findings, placental pathology, and neonatal outcomes were collected and analyzed. A total of 12 cases were analyzed. The incidence of umbilical cord vascular rupture during childbirth was 0.08%. The FHR patterns in umbilical cord rupture during delivery included baseline tachycardia, minimal or absent variability, variable or late deceleration, prolonged deceleration, and undetectable heart rate. The bradycardia-to-delivery interval (BDI) ranged from 6 to 26 minutes. Among the 12 neonates, 9 were discharged well, 2 were stillbirths, and there was 1 neonatal death. Hemorrhagic shock was common in live births. Our study highlights the significance of continuous FHR monitoring during labor and the urgent need for medical teams to respond quickly in cases of umbilical cord vascular rupture. Despite advancements in neonatal resuscitation techniques, managing cases with undetectable fetal heart activity remains clinically challenging, and even with immediate pregnancy termination, poor neonatal outcomes may still occur. · Umbilical cord vascular rupture during labor is a rare event.. · Its clinical management presents significant challenges.. · Advances in neonatal resuscitation have improved rescue success rates.. · In such cases, hemorrhagic shock is common in live births..

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge regarding Cardio Pulmonary Resuscitation among Higher Secondary School Students in Selected Schools, Aizawl, Mizoram

Background: Cardio pulmonary resuscitation is a process of oxygenating heart, lung through external cardiac massage and artificial respiration until the definite medical treatment can restore the normal functioning of heart, lung and brain. Cardio pulmonary resuscitation (CPR) is a lifesaving technique that is useful in many emergencies in which someone's breathing or heartbeat has stopped. The purpose of this study is to assess the knowledge and effectiveness of Structured Teaching Programme regarding cardio pulmonary resuscitation among higher secondary school students. Methods: The research design used in the study was one group pre-test post-test design, in which stratified random sampling technique was used to select 100 students of Govt. Chaltlang Higher Secondary School. Self-Structured Knowledge Questionnaires was used to collect the Data. Post test was conducted after 7 days using the same self-structured knowledge questionnaires used for the pre- test. Results: The mean difference between the pre - test and post- test knowledge score was found to be 12.29 with t-value=-24.82, & p value =0.05 which indicates that indicates that Structured Teaching Programme regarding cardio pulmonary resuscitation was effective. Thus, the research Hypothesis H 1 is accepted. Conclusion: The overall findings of the study suggested that Structured Teaching Programme on Cardio pulmonary resuscitation was significantly effective in improving the knowledge of students regarding Cardio pulmonary resuscitation technique.

Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest

Abstract Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.

Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta

BackgroundAortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal hemorrhage. Despite diagnostic and therapeutic advances, the mortality rate in AEF patients remains high because of its fulminant course, even with maximal intensive care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a resuscitation technique to control life-threatening bleeding. It has become an important modality in the management of life-threatening, traumatic or non-traumatic, arterial bleeding. However, it’s use in hemorrhagic shock caused by cancer has rarely been reported.Case presentationA 51-year-old woman with a history of esophageal cancer presented to our emergency department with hematemesis. Computed tomography was performed because of a strong suspicion of hemorrhagic shock. With a diagnosis of AEF due to esophageal cancer, emergency thoracic endovascular aortic repair was performed while the bleeding was controlled using REBOA. Staged elective esophageal reconstruction was successfully performed.ConclusionsHemostasis is crucial in patients who present with suspected hemorrhagic shock attributable to AEF. The timely implementation of REBOA has shown promise and potential effectiveness in such cases.

Open-chest cardiopulmonary resuscitation through a transdiaphragmatic approach in dogs: a cadaveric study to describe the surgical approach and manipulations.

To describe the detailed surgical procedure for open-chest CPR (OC-CPR) through a transdiaphragmatic (TD) approach during planned laparotomy and to evaluate the procedure time and damage to organs. 7 mixed-breed canine cadavers. The procedure was divided into 3 stages. Durations for each of the 3 stages of the procedure and total time from diaphragmatic incision to the end of Rumel tourniquet application were recorded. Subjective assessment of ease of procedures and postprocedural physical evaluation of thoracoabdominal organs were also performed. Mean time from diaphragmatic incision to pericardiotomy was 15.1 seconds (SD, 4.0). Performing 10 cardiac compressions took 12.0 seconds (SD, 1.8). Dissection of the aorta and application of a Rumel tourniquet took 130.4 seconds (SD, 52.2). The mean total time from start of first procedure to end of last procedure was 157.6 seconds (SD, 21.5). The mean length of diaphragmatic incision was 11.5 cm (SD, 2.2). Lung laceration was identified in one dog, and liver laceration was identified in another dog. The mean ease of pericardiotomy was 10, and application of a Rumel tourniquet was 4 (SD, 1.9). There was no instance of abdominal organs moving into the thoracic cavity during the procedure in any of the dogs. Resuscitation techniques during TD OC-CPR can be performed with acceptable timing and effort, except for aortic Rumel tourniquet application, which was difficult and time consuming. Avoidable damage to thoracoabdominal organs can occur.

Modernization of Cardiac Advanced Life Support: Role and Value of Cardiothoracic Anesthesiologist Intensivist in Post–Cardiac Surgery Arrest Resuscitation

Cardiac arrest in the post-operative cardiac surgery patient requires a unique set of management skills that deviates from traditional cardiopulmonary resuscitation and Advanced Cardiovascular Life Support (ACLS). Cardiac Advanced Life Support (CALS) was first proposed in 2005 to address these intricacies. The hallmark of CALS is early chest reopening and internal cardiac massage within five minutes of the cardiac arrest in patients unresponsive to basic life support. Since the introduction of CALS, the landscape of cardiac surgery has continued to evolve.Cardiac intensivists encounter more patients who undergo cardiac surgical procedures performed via minimally invasive techniques such as lateral thoracotomy or mini sternotomy, in which an initial bedside sternotomy for cardiac massage is not applicable. Given the heterogeneous nature of the patient population in the cardiothoracic intensive care unit (CTICU), personnel must expeditiously identify the most appropriate rescue strategy. As such, we have proposed a modified CALS approach to (1) adapt to a newer generation of cardiac surgery patients and (2) incorporate advanced resuscitative techniques. These include rescue-focused cardiac ultrasound to aid in the early identification of underlying pathology and guide resuscitation and early institution of extracorporeal cardiopulmonary resuscitation (ECPR) instead of chest re-opening. While these therapies are not immediately available in all cardiac surgery centers, we hope this creates a framework to revise guidelines to include these recommendations to improve outcomes and how cardiac anesthesiologist intensivists' evolving role can aid resuscitation.

Causes of mortality in military working dog from traumatic injuries.

This study aimed to identify the pathophysiologic causes of death following traumatic injuries in military working dogs (MWDs) and determine the risk factors associated with mortality in MWD following traumatic injuries. The results of this study will allow for better targeting of interventions to ameliorate these pathophysiologic causes of death and inform research priorities directed at the pathophysiology that leads to the death of MWDs. The final dataset for this study was compiled by using two previously established datasets. Based on review of available data and supplemental records (when available), MWDs in which a definitive cause of death could be determined were included in the study population. These MWDs were assigned a cause of death based on categories previously identified in studies evaluating service member casualties. A group of MWDs who survived their traumatic injury and had similar mechanisms of injury and types of injury to the deceased MWDs were included to allow for comparison and establishment of risk factors associated with MWD death. Variables collected included breed, age, sex, mechanism of injury, survival/non-survival, type of trauma, mechanism of injury, pathophysiology that led to death and pre-hospital care provided. Statistical analysis included Fishers exact test for categorical variables and univariable and multivariable logistic regression to identify factors associated with the MWD death. A total of 84 MWDs (33 non-survivors and 51 survivors) were included in this study. Of the 33 MWDs that died, 27 (81.8%) were noted to be dead on arrival. The pathophysiologic causes of death were found to be hemorrhage (45.5% [n = 15]), head trauma (21.2% [n = 7]), catastrophic tissue destruction (15.2% [n = 5]), pneumothorax (9.1% [n = 3]) and one (3% [n = 1]) of each of the following: septic shock, asphyxiation and burns. Military working dogs that did not receive non-DVM care were 3.55 times more likely to die than those that did receive non-DVM care (95% CI 1.03-12.27). The majority of MWDs died of their injuries before reaching veterinary care. To increase the survival of MWDs on the battlefield, further research should focus on developing new interventions and techniques to mitigate the effects of the pathophysiology noted to cause MWD death. Furthermore, given that care by a non-DVM was found to be associated with survival, the implementation of pre-hospital care and early resuscitation techniques should be a continued priority for those treating MWDs at both the point of injury and in the prehospital setting.

Diagnosis of apparent death and resuscitation techniques in 18th century Spain: a historical analysis

Diagnosis of apparent death and resuscitation techniques in 18th century Spain: a historical analysis

Neuroprotective Approaches for Brain Injury After Cardiac Arrest: Current Trends and Prospective Avenues.

With the implementation of improved bystander cardiopulmonary resuscitation techniques and public-access defibrillation, survival after out-of-hospital cardiac arrest (OHCA) has increased significantly over the years. Nevertheless, OHCA survivors have residual anoxia/reperfusion brain damage and associated neurological impairment resulting in poor quality of life. Extracorporeal membrane oxygenation or targeted temperature management has proven effective in improving post-cardiac arrest (CA) neurological outcomes, yet considering the substantial healthcare costs and resources involved, there is an urgent need for alternative treatment strategies that are crucial to alleviate brain injury and promote recovery of neurological function after CA. In this review, we searched PubMed for the latest preclinical or clinical studies (2016-2023) utilizing gas-mediated, pharmacological, or stem cell-based neuroprotective approaches after CA. Preclinical studies utilizing various gases (nitric oxide, hydrogen, hydrogen sulfide, carbon monoxide, argon, and xenon), pharmacological agents targeting specific CA-related pathophysiology, and stem cells have shown promising results in rodent and porcine models of CA. Although inhaled gases and several pharmacological agents have entered clinical trials, most have failed to demonstrate therapeutic effects in CA patients. To date, stem cell therapies have not been reported in clinical trials for CA. A relatively small number of preclinical stem-cell studies with subtle therapeutic benefits and unelucidated mechanistic explanations warrant the need for further preclinical studies including the improvement of their therapeutic potential. The current state of the field is discussed and the exciting potential of stem-cell therapy to abate neurological dysfunction following CA is highlighted.

PREBOA vs ER-REBOA impact on blood utilization and resuscitation requirements: A pilot analysis.

Partial occlusion of the aorta is a resuscitation technique designed to maximize proximal perfusion while allowing a graduated amount of distal flow to reduce the ischemic sequelae associated with complete aortic occlusion. The pREBOA catheter affords the ability to titrate perfusion as hemodynamics allows, however, the impact of this new technology for REBOA on blood use and other resuscitative requirements is currently unknown. We hypothesize pREBOA's ability to provide partial occlusion, when appropriate, decreases overall resuscitative requirements when compared to ER-REBOA. The entire AAST AORTA Registry was used to compare resuscitation requirements between all ER-REBOA and pREBOA. Unpaired t-tests were used to compare resuscitation strategies including packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate, crystalloids, and need for pressors. When comparing ER-REBOA (n=800) use to pREBOA (n=155), initial patient presentations were similar except for age (44 vs 40 p=0.026) and rates of blunt injury (78.4% vs 78.7% p<0.010). Zone-1 occlusion was used less often in ER-REBOA (65.8 vs 71.7 p=0.046). Partial occlusion was performed in 85% of pREBOA compared to 11% in ER-REBOA (p<0.050). Vitals at the time of REBOA were worse in ER-REBOA, and received significantly more units of PRBCs, FFP, platelets, and liters of crystalloids than pREBOA (p<0.05). Rates of ARDS and septic shock were lower in pREBOA (p<0.05). When comparing pREBOA to ER-REBOA, there has been a rise in Zone-1 and partial occlusion. In our pilot analysis of the AORTA Registry, there was a reduction in administration of pRBC, FFP, platelets, and crystalloids. Though further prospective studies are required, this is the first to demonstrate an association between pREBOA, partial occlusion, and reduced blood use and resuscitative requirements.

Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest (OHCA) in the United States

IntroductionHelicopter emergency medical services (HEMS) are used in the United States and globally to respond to patients with critical illness and victims of traumatic injury. Relatively limited research has examined their role in responding to out-of-hospital cardiac arrests (OHCA) in the United States. In this study, we compared OHCA treated by HEMS units with cardiac arrests treated by ground ambulances. MethodsWe queried a large national-level database of emergency medical services (EMS) activations in the United States (NEMSIS). Inclusion criteria were OHCA activations between January 1, 2022 and December 31, 2022 treated by either HEMS or ground ambulance. Key arrest data from both groups were then compared. Interfacility transfers and cardiac arrests after EMS arrival were excluded. ResultsA total of 1,233 cardiac arrests treated by HEMS and 341,096 cardiac arrests treated by ground ambulances met inclusion criteria. Comparing the two groups, cardiac arrests with HEMS response were more likely to be male (66.7% vs. 62.8%, p < 0.01), White (50.2% vs. 45.7%, p < 0.01), under 18 years old (10.9% vs. 2.7%, p < 0.001), associated with traumatic injury (19.1% vs. 5.7%, p < 0.001), witnessed (72.7% vs. 37.3%, p < 0.001), and initially-shockable (24.7% vs. 11.1%, p < 0.001). ConclusionOur comparison of cardiac arrests treated by HEMS with cardiac arrests treated by ground ambulance reveals significant differences between the two groups. Further research is needed to better characterize HEMS’ ideal role in the response to OHCA as new prehospital resuscitative techniques for non-traumatic and traumatic cardiac arrest are developed.

Cardiac Arrest in Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant global health concern with substantial contributions to illness and mortality rates. This study aims to scrutinize the intricate interplay between neurological and circulatory abnormalities post-TBI, particularly focusing on the challenge posed by cardiac arrest in TBI patients. The study employs a comprehensive approach, utilizing clinical assessments, electrocardiograms, intracranial pressure monitoring, brain imaging, and biomarker utilization. It explores the effectiveness of these methods in detecting cardiac arrest in TBI patients. Additionally, the research delves into resuscitation techniques, hemodynamic stabilization, intracranial pressure management, and neurological enhancement as potential therapeutic modalities. The results highlight the importance of prompt initiation of cardiopulmonary resuscitation and adherence to advanced cardiac life support protocols in TBI patients with cardiac arrest. Prognostic factors such as injury severity, response time, effectiveness of resuscitation interventions, and pre-existing medical conditions are identified as crucial elements in predicting cardiac arrest outcomes in TBI patients. The study concludes by emphasizing the critical necessity of a comprehensive approach to understand and manage the complex relationship between cardiac arrest and TBI. Incorporating scientific discoveries, clinical perspectives, and technological advancements, the review underscores the importance of addressing this multifaceted medical challenge through a thorough analysis and effective management strategies.

Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review.

Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.

Characteristics of traumatic major haemorrhage in a tertiary trauma center

BackgroundMajor traumatic haemorrhage is potentially preventable with rapid haemorrhage control and improved resuscitation techniques. Although advances in prehospital trauma management, haemorrhage is still associated with high mortality. The aim of this study was to use a recent pragmatic transfusion-based definition of major bleeding to characterize patients at risk of major bleeding and associated outcomes in this cohort after trauma.MethodsThis was a retrospective cohort study including all trauma patients (n = 7020) admitted to a tertiary trauma center from January 2015 to June 2020. The major bleeding cohort (n = 145) was defined as transfusion of 4 units of any blood components (red blood cells, plasma, or platelets) within 2 h of injury. Univariate and multivariable logistic regression analyses were performed to identify risk factors for 24-hour and 30-day mortality post trauma admission.ResultsIn the major bleeding cohort (n = 145; 145/7020, 2.1% of the trauma population), there were 77% men (n = 112) and 23% women (n = 33), median age 39 years [IQR 26–53] and median Injury Severity Score (ISS) was 22 [IQR 13–34]. Blunt trauma dominated over penetrating trauma (58% vs. 42%) where high-energy fall was the most common blunt mechanism and knife injury was the most common penetrating mechanism. The major bleeding cohort was younger (OR 0.99; 95% CI 0.98 to 0.998, P = 0.012), less female gender (OR 0.66; 95% CI 0.45 to 0.98, P = 0.04), and had more penetrating trauma (OR 4.54; 95% CI 3.24 to 6.36, P = 0.001) than the rest of the trauma cohort. A prehospital (OR 2.39; 95% CI 1.34 to 4.28; P = 0.003) and emergency department (ED) (OR 6.91; 95% CI 4.49 to 10.66, P = 0.001) systolic blood pressure < 90 mmHg was associated with the major bleeding cohort as well as ED blood gas base excess < -3 (OR 7.72; 95% CI 5.37 to 11.11; P < 0.001) and INR > 1.2 (OR 3.09; 95% CI 2.16 to 4.43; P = 0.001). Emergency damage control laparotomy was performed more frequently in the major bleeding cohort (21.4% [n = 31] vs. 1.5% [n = 106]; OR 3.90; 95% CI 2.50 to 6.08; P < 0.001). There was no difference in transportation time from alarm to hospital arrival between the major bleeding cohort and the rest of the trauma cohort (47 [IQR 38;59] vs. 49 [IQR 40;62] minutes; P = 0.17). However, the major bleeding cohort had a shorter time from ED to first emergency procedure (71.5 [IQR 10.0;129.0] vs. 109.00 [IQR 54.0; 259.0] minutes, P < 0.001). In the major bleeding cohort, patients with penetrating trauma, compared to blunt trauma, had a shorter alarm to hospital arrival time (44.0 [IQR 35.5;54.0] vs. 50.0 [IQR 41.5;61.0], P = 0.013). The 24-hour mortality in the major bleeding cohort was 6.9% (10/145). All fatalities were due to blunt trauma; 40% (4/10) high energy fall, 20% (2/10) motor vehicle accident, 10% (1/10) motorcycle accident, 10% (1/10) traffic pedestrian, 10% (1/10) traffic other, and 10% (1/10) struck/hit by blunt object. In the logistic regression model, prehospital cardiac arrest (OR 83.4; 95% CI 3.37 to 2063; P = 0.007) and transportation time (OR 0.95, 95% CI 0.91 to 0.99, P = 0.02) were associated with 24-hour mortality.ResultsEarly identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control. The major bleeding trauma cohort is a small part of the entire trauma population, and is characterized of being younger, male gender, higher ISS, and exposed to more penetrating trauma. Early identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control.

Caregivers’ Perceptions of Do Not Resuscitate Orders: A Qualitative Study in Rural Southwestern Kenya

The need for palliative care services has increased with the rise of patients with terminal illnesses. Unfortunately, there is a need for more research in palliative care, especially on end-of-life care. Conversations during that period present an ethical and cultural challenge in both collectivistic and individualistic societies. Worldwide, the laws regulating Do Not Resuscitate orders differ from country to country. The perceptions also vary from society to society. Studies have shown the need to involve families in this era of rising advocacy for patient-centered care. Caregivers have an essential role in decision-making and are involved in end-of-life decisions. This study aimed to describe caregivers' perceptions of Do Not Resuscitate orders. The study used a qualitative approach and phenomenological research design. It involved eighteen caregivers of patients receiving palliative care. The sampling procedure was non-probability purposive. Data was collected using in-depth interviews and analyzed using thematic analysis. Overall, two themes emerged from the findings. The first theme was a lack of awareness of the Do Not Resuscitate orders and the resuscitation techniques, and the second theme was subjective perceptions based on caregivers' beliefs and emotional responses. Caregivers need counseling, preparation, and education on Do Not Resuscitate orders and resuscitation methods to improve Do Not Resuscitate discussions. Healthcare providers need to be empowered to hold those discussions.

Impact of Basic Life Support Training Program among Saudi Primary School Teachers in Riyadh

Introduction: Basic Life Support (BLS) training plays a crucial role in equipping individuals to provide immediate emergency care until medical help is available. In the school setting, where injuries are common among students, teachers serve as primary caregivers and first responders. This study aimed to assess the impact of BLS training on the resuscitation knowledge and skills of primary school teachers in Riyadh, Saudi Arabia.Methods: A randomized interventional trial was conducted with 48 primary school teachers, aged 23 to 50 years. After providing a concise BLS training program, participants completed a pre-and post-test questionnaire assessing their understanding of resuscitation techniques. Descriptive statistics and chi-square tests were used for data analysis.Results: Before the BLS training, the participants demonstrated limited knowledge and skills in resuscitation techniques. For instance, only 20.8% correctly identified the ideal compression depth, and 33.3% were unsure about the ideal steps for Basic Life Support. However, after the training, a significant improvement was observed in participants' knowledge and skills, with a higher percentage answering correctly in the post-training questionnaire (e.g., 87.5% correctly identified the recommended compression rate, and 75% accurately identified the ideal steps for Basic Life Support). Conclusion: This study highlights the positive impact of BLS training on the resuscitation knowledge and skills of primary school teachers in Riyadh. Primary school teachers can enhance emergency response capabilities and contribute to student safety, by providing teachers with the necessary knowledge and practical skills. These findings emphasize the importance of implementing targeted training programs in schools to improve resuscitation education for teachers.