Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR

Introduction

We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR.

Methods

In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children.

Results

A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P < 0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively.

Conclusions

Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren.     

Influence of nationwide policy on citizens’ awareness and willingness to perform bystander cardiopulmonary resuscitation

Aims

Public awareness to cardiopulmonary resuscitation (CPR) and cardiac arrest is influenced by systemic factors including related policies and legislations in the community. Here, we describe and compare the results of the two nationwide CPR surveys in 2007 and 2011 examining public awareness and attitudes to bystander CPR in South Korea along with changes in nationwide CPR policies and systemic factors.

Methods

This population-based study used specially designed questionnaires via telephone surveys. We conducted bi-temporal surveys by stratified cluster sampling to assess the impact of age, gender, and geographic regions in 2007 (n = 1029) and in 2011 (n = 1000). Logistic regression analysis was performed to identify factors associated with willingness to perform bystander CPR.

Results

Public awareness of automated external defibrillators increased from 3.0% in 2007 to 32.6% in 2011. The proportion of the population that underwent CPR training within the previous 2 years increased significantly from 26.9% to 49.0%. The factors most related with intention of bystander CPR were male gender, younger age, CPR awareness, recent CPR training, and qualified CPR learning. In 2011, 75.8% of respondents were more willing to perform bystander CPR for stranger vs. 68.3% in 2007 (p = 0.002). Additional dispatcher hands-only CPR increased this proportion (85.8%, p < 0.001). However, bystander CPR experience rates remained unchanged (3.6–3.9%).

Conclusion

Changes in nationwide CPR policies and systemic factors affected citizens’ awareness and willingness to perform bystander CPR. Additionally, applied dispatcher hands-only CPR and publicity increased public willingness to perform bystander CPR.     

Performing bystander CPR for sudden cardiac arrest: Behavioral intentions among the general adult population in Arizona

Study objectives

The odds of surviving an out-of-hospital cardiac arrest are significantly improved by the provision of bystander cardiopulmonary resuscitation (CPR), but many cardiac arrest victims do not receive it. The existing literature remains equivocal as to why people are unwilling to perform traditional CPR. This study's objectives were to determine the behavioral intentions of the general population in Arizona regarding performing bystander CPR and to assess the reasons for being unwilling to perform CPR.

Methods

This was a general population survey using a mailed, self-administered questionnaire. The questionnaire was mailed to random samples of Arizona residents in a rural and urban county.

Results

Usable questionnaires were received from 49.5% (n = 370) and 49.6% (n = 385) of the samples from the urban and rural county, respectively. More than 50% of respondents reported being willing to perform CPR on a stranger and over 80% reported being willing to perform CPR on a family member. There were no significant differences between the proportions of respondents in each county willing to perform CPR. The reasons for not being willing to perform CPR were relatively evenly divided among the five reasons listed.

Conclusions

Although our findings likely overestimate the proportion of individuals who would perform bystander CPR, the relative importance of the reasons for not performing CPR is informative. Based on the reasons reported, there is potential to change the CPR-related attitudes, beliefs, and skill levels of the general public to enhance the number of people willing and able to perform bystander CPR.     

Training hospital providers in basic CPR skills in Botswana: Acquisition,retention and impact of novel training techniques

Objective

Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana.

Methods

HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation.

Results

Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p < 0.01; adult 28% vs. 48%, p < 0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p < 0.01) and 6 months (38% vs. 67%, p < 0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance.

Conclusions

HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.     

Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance

Objective

The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training.

Methods

This study was a single blind randomized controlled trial. The participants’ last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n = 42) and the control group (n = 38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the Resusci^®Anne SkillReporter™.

Results

Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (p < 0.001). Psychomotor skills evaluated with the AA-CPRII group demonstrated better performance in hand positioning (p = 0.025), compression depth (p = 0.035) and compression rate (p < 0.001) than the control group.

Conclusion

The AA-CPRII group resulted in better checklist scores, including chest compression rate, depth and hand positioning. Animation-assisted CPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR.     

Quality of CPR performed by trained bystanders with optimized pre-arrival instructions

Objective

Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR.

Method

Ninety-five trained rescuers aged 22–69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing.

Results

Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p = 0.014) and compressed more frequently to a compression rate between 90 and 120 min⁻¹ (median 87% vs. 60% of compressions, p < 0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12 s vs. 64 s, p < 0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p < 0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups.

Conclusion

In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions.     

CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study of victims after unsuccessful resuscitation

Aim

The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest.

Methods

In this prospective multicentre trial, including 222 patients (83 manual CPR/139 mechanical CPR), autopsies were conducted after unsuccessful CPR and the results were evaluated according to a specified protocol.

Results

Among the patients included, 75.9% in the manual CPR group and 91.4% in the mechanical CPR group (p = 0.002) displayed CPR-related injuries. Sternal fractures were present in 54.2% of the patients in the manual CPR group and in 58.3% in the mechanical CPR group (p = 0.56). Of the patients in the manual CPR group, there were 64.6% with at least one rib fracture versus 78.8% in the mechanical CPR group (p = 0.02). The median number of rib fractures among patients with rib fractures was 7 in the manual CPR group and 6 in the mechanical CPR group. No CPR-related injury was considered to be the cause of death.

Conclusion

In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.     

The relationship between chest compression fraction and outcome from ventricular fibrillation arrests in prolonged resuscitations

Background

Guidelines direct rescuers to minimize CPR interruptions during resuscitation. There is little evidence that evaluates the relationship of increasing CPR fraction among patients with relatively high fractions or prolonged resuscitation.

Methods

We conducted an observational study of persons who suffered out-of-hospital ventricular fibrillation arrest and required >5 min of emergency medical services (EMS) CPR for persistent pulselessness. We determined the association between hands-on CPR fraction and outcomes of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Analyses were stratified by median hands-on CPR and were conducted for those who required 5, 10, and 20 min of EMS CPR for persistent pulselessness.

Results

Of 414 potentially eligible patients, 323 (78%) required >5 min of EMS CPR, 234 (56%) required >10 min of EMS CPR, and 153 (37%) required EMS CPR for >20 min. The median CPR fraction was 81%. We did not observe a significant association for the outcomes of hospital survival and neurologically favorable survival for the 5-min and 10-min groups. When restricted to patients who required >20 min of EMS CPR, the half who received a higher hands-on CPR fraction were more likely to achieve spontaneous circulation (40% versus 18%, p = 0.004), survival to hospital discharge (20% versus 8%, p = 0.03), and neurologically favorable survival (20% versus 7%, p = 0.02).

Conclusion

Over one-third required 20 min of persistent EMS CPR. The EMS was able to achieve a high hands-on CPR fraction in the context of advanced therapies. Those who required the most prolonged EMS CPR appeared to benefit from greater hands-on CPR fraction.     

Performance of the i-gel™ during pre-hospital cardiopulmonary resuscitation

Background

Current cardiopulmonary resuscitation (CPR) guidelines recommend airway management and ventilation whilst minimising interruptions to chest compressions. We have assessed i-gel™ use during CPR.

Methods

In an observational study of i-gel™ use during CPR we assessed the ease of i-gel™ insertion, adequacy of ventilation, the presence of a leak during ventilation, and whether ventilation was possible without interrupting chest compressions.

Results

We analysed i-gel™ insertion by paramedics (n = 63) and emergency physicians (n = 7) in 70 pre-hospital CPR attempts. There was a 90% first attempt insertion success rate, 7% on the second attempt, and 3% on the third attempt. Insertion was reported as easy in 80% (n = 56), moderately difficult in 16% (n = 11), and difficult in 4% (n = 3). Providers reported no leak on ventilation in 80% (n = 56), a moderate leak in 17% (n = 12), and a major leak with no chest rise in 3% (n = 2). There was a significant association between ease of insertion and the quality of the seal (r = 0.99, p = 0.02). The i-gel™ enabled continuous chest compressions without pauses for ventilation in 74% (n = 52) of CPR attempts. There was no difference in the incidence of leaks on ventilation between patients having continuous chest compressions and patients who had pauses in chest compressions for ventilation (83% versus 72%, p = 0.33, 95% CI [−0.1282, 0.4037]). Ventilation during CPR was adequate during 96% of all CPR attempts.

Conclusions

The i-gel™ is an easy supraglottic airway device to insert and enables adequate ventilation during CPR.     

Aspects on the increase in bystander CPR in Sweden and its association with outcome

Aim

To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times.

Patients and methods

All patients who suffered from OHCA in Sweden in whom CPR was attempted and who were included in the Swedish cardiac arrest register (SCAR) between 1992 and 2005. Crew witnessed cases were excluded.

Results

In all 34,125 patients were included in the survey. Among witnessed OHCA the proportion of patients receiving bystander CPR increased from 40% in 1992 to 55% in 2005 (p < 0.0001). In non-witnessed OHCA the corresponding proportion increased from 22% to 44% (p < 0.0001). There was a significant increase in bystander CPR regardless of age, sex and place. The increase was only found when CPR was performed by lay persons (21% in 1992 to 40% in 2005; p < 0.0001). Bystander CPR was associated with an increased proportion of patients found in a shockable rhythm and a lower number of shocks to receive return of spontaneous circulation. Bystander CPR was associated with a similar increase in survival early and late in the evaluation.

Conclusion

There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.     

The benefits of a simplified method for CPR training of medical professionals: A randomized controlled study

Objectives

We developed and tested a training method for basic life support incorporating defibrillator feedback during simulated cardiac arrest (CA) to determine the impact on the quality and retention of CPR skills.

Methods

298 subjects were randomized into 3 groups. All groups received a 2 h training session followed by a simulated CA test scenario, immediately after training and at 3 months. Controls used a non-feedback defibrillator during training and testing. Group 1 was trained and tested with an audiovisual feedback defibrillator. During training, Group 1 reviewed quantitative CPR data from the defibrillator. Group 2 was trained as per Group 1, but was tested using the non-feedback defibrillator. The primary outcome was difference in compression depth between groups at initial testing. Secondary outcomes included differences in rate, depth at retesting, compression fraction, and self-assessment.

Results

Groups 1 and 2 had significantly deeper compressions than the controls (35.3 ± 7.6 mm, 43.7 ± 5.8 mm, 42.2 ± 6.6 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. controls; P = 0.001 for Group 2 vs. controls). At three months, CPR depth was maintained in all groups but remained significantly higher in Group 1 (39.1 ± 9.9 mm, 47.0 ± 7.4 mm, 42.2 ± 8.4 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. control). No significant differences were noted between groups in compression rate or fraction.

Conclusions

A simplified 2 h training method using audiovisual feedback combined with quantitative review of CPR performance improved CPR quality and retention of these skills.     

A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest

Background

Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) system has been successfully used to support patients with in- and out-of-hospital cardiac arrest (IHCA, OHCA) when conventional measures have failed. The purpose of the current study is to report on our experience with extracorporeal CPR in non-postcardiotomy patients.

Methods

We retrospectively analysed a total of 85 consecutive adult patients, who have been treated with ECLS between January 2007 and January 2012.

Results

The mean CPR duration was 40 min (20–70 min). The mean ECLS support duration was 49 h (12–92 h). Twenty-eight patients (33%) had ECLS related complications. Forty patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% were without severe neurologic deficit. Duration of CPR was shorter for survivors than for non-survivors [(25: 20–50 min) vs. (50: 25–86 min); p = 0.003]. Immediately after ECLS start, the mean blood lactate level was lower (p = 0.003), and the mean pH value was higher in the survivors’ group (p < 0.0001) compared to the non-survivors’ group. The CPR duration for the IHCA group (25: 20–50 min) was shorter compared to the OHCA group (70: 55–110 min; p < 0.0001). The survival rate in this group was higher compared to the OHCA group (42% vs. 15%; p < 0.02).

Conclusions

CPR using modern miniaturized ECLS systems should be established in the treatment of prolonged cardiac arrest and unsuccessful conventional CPR in selected patients. CPR with ECLS for OHCA has worse outcomes compared to IHCA. Duration of CPR was independent risk factor for mortality after extracorporeal CPR.     

Ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents

Aim

Performance of high quality CPR is associated with improved resuscitation outcomes. This study investigates code leader ability to recall CPR error during post-event interviews when CPR recording/audiovisual feedback-enabled defibrillators are deployed.

Patients and methods

Physician code leaders were interviewed within 24 h of 44 in-hospital pediatric cardiac arrests to assess their ability to recall if CPR error occurred during the event. Actual CPR quality was assessed using quantitative recording/feedback-enabled defibrillators. CPR error was defined as an overall average event chest compression (CC) rate <95/min, depth <38 mm, ventilation rate >10/min, or any interruptions in CPR >10 s. We hypothesized that code leaders would recall error when it actually occurred ≥75% of the time when assisted by audiovisual alerts from a CPR recording feedback-enabled defibrillators (analysis by χ²).

Results

810 min from 44 cardiac arrest events yielded 40 complete data sets (actual and interview); ventilation data was available in 24. Actual CPR error was present in 3/40 events for rate, 4/40 for depth, 32/40 for interruptions >10 s, and 17/24 for ventilation frequency. In post-event interviews, code leaders recalled these errors in 0/3 (0%) for rate, 0/4 (0%) for depth, and 19/32 (59%) for interruptions >10 s. Code leaders recalled these CPR quality errors less than 75% of the time for rate (p = 0.06), for depth (p < 0.01), and for CPR interruption (p = 0.04). Quantification of errors not recalled: missed rate error median = 94 CC/min (IQR 93–95), missed depth error median = 36 mm (IQR 35.5–36.5), missed CPR interruption >10 s median = 18 s (IQR 14.4–28.9). Code leaders did recall the presence of excessive ventilation in 16/17 (94%) of events (p = 0.07).

Conclusion

Despite assistance by CPR recording/feedback-enabled defibrillators, pediatric code leaders fail to recall important CPR quality errors for CC rate, depth, and interruptions during post-cardiac arrest interviews.     

A clinical observational study analysing the factors associated with hyperventilation during actual cardiopulmonary resuscitation in the emergency department

Aim

This is the first study to identify the factors associated with hyperventilation during actual cardiopulmonary resuscitation (CPR) in the emergency department (ED).

Methods

All CPR events in the ED were recorded by video from April 2011 to December 2011. The following variables were analysed using review of the recorded CPR data: ventilation rate (VR) during each minute and its associated factors including provider factors (experience, advanced cardiovascular life support (ACLS) certification), clinical factors (auscultation to confirm successful intubation, suctioning, and comments by the team leader) and time factors (time or day of CPR).

Results

Fifty-five adult CPR cases including a total of 673 min sectors were analysed. The higher rates of hyperventilation (VR > 10/min) were delivered by inexperienced (53.3% versus 14.2%) or uncertified ACLS provider (52.2% versus 10.8%), during night time (61.0 versus 34.5%) or weekend CPR (53.1% versus 35.6%) and when auscultation to confirm successful intubation was performed (93.5% versus 52.8%) than not (all p < 0.0001). However, experienced (25.3% versus 29.7%; p = 0.448) or certified ACLS provider (20.6% versus 31.3%; p < 0.0001) could not deliver high rate of proper ventilation (VR 8–10/min). Comment by the team leader was most strongly associated with the proper ventilation (odds ratio 7.035, 95% confidence interval 4.512–10.967).

Conclusions

Hyperventilation during CPR was associated with inexperienced or uncertified ACLS provider, auscultation to confirm intubation, and night time or weekend CPR. And to deliver proper ventilation, comments by the team leader should be given regardless of providers’ expert level.     

A Simple Audio-visual Prompt Device Can Improve CPR Performance

Background

An adjunct to assist cardiopulmonary resuscitation (CPR) might improve the quality of CPR performance.

Study Objectives

This study was conducted to evaluate whether a simple audio-visual prompt device improves CPR performance by emergency medical technicians (EMTs).

Methods

From June 2008 to October 2008, 55 EMTs (39 men, mean age 34.9 ± 4.8 years) participated in this study. A simple audio-visual prompt device was developed. The device generates continuous metronomic sounds for chest compression at a rate of 100 beats/min with a distinct 30^th sound followed by two respiration sounds, each for 1 second. All EMTs were asked to perform a 2-min CPR series on a manikin without the device, and one 2-min CPR series with the device.

Results

The average rate of chest compressions was more accurate when the device was used than when the device was not used (101.4 ± 12.7 vs. 109.0 ± 17.4/min, respectively, p = 0.012; 95% confidence interval [CI] 97.2–103.8 vs. 104.5–113.5/min, respectively), and hands-off time during CPR was shorter when the device was used than when the device was not used (5.4 ± 0.9 vs. 9.2 ± 3.9 s, respectively, p < 0.001; 95% CI 5.2–5.7 vs. 8.3–10.3 s, respectively). The mean tidal volume during CPR with the device was lower than without the device, resulting in the prevention of hyperventilation (477.6 ± 60.0 vs. 636.6 ± 153.4 mL, respectively, p < 0.001; 95% CI 463.5–496.2 vs. 607.3–688.9 mL, respectively).

Conclusion

A simple audio-visual prompt device can improve CPR performance by emergency medical technicians.     

Should dispatchers instruct lay bystanders to undress patients before performing CPR? A randomized simulation study

Objective

Dispatch-assisted CPR instructions frequently direct bystanders to remove a cardiac arrest patient's clothing prior to starting chest compressions. Removing clothing may delay compressions and it is uncertain whether CPR quality is influenced by the presence of clothing. We measured how instructions to remove clothing impacted the time to compressions and CPR performance by lay responders in a simulated arrest.

Subjects and methods

We conducted a randomized dispatch-assisted CPR simulation trial. Fifty two lay participants were instructed to remove the manikin's clothing (3 layers: a t-shirt, button-down shirt, and fleece vest) prior to starting chest compressions as part of dispatcher instructions, while 47 individuals received no instruction about clothing removal. Instructions were otherwise identical.

Results

The two groups were comparable with regard to demographic characteristics and prior CPR training. Time to first compression was 109 s among the group randomized to instruction to remove clothing and 79 s among those randomized to forgo instruction regarding clothing removal, (p < 0.001). Among those randomized to remove clothing instructions, mean compression depth was 41 mm, compression rate was 97 per minute, and the percentage with complete compression release was 95%. Among those randomized to forgo clothing removal instruction, mean compression depth was 40 mm, compression rate was 99 per minute, and the percentage with complete compression release was 91% (p > 0.05 for each CPR metric comparison).

Conclusion

These findings suggest that eliminating instruction to remove a victim's clothing in dispatcher-assisted CPR will save time without compromising performance, which may improve survival from cardiac arrest.     

An assessment of resuscitation quality in the television drama Emergency Room: Guideline non-compliance and low-quality cardiopulmonary resuscitation lead to a favorable outcome?

Objective

Two earlier studies found that outcome after cardiopulmonary resuscitation (CPR) in the television medical drama Emergency Room (ER) is not realistic. No study has yet evaluated CPR quality in ER.

Design

Retrospective analysis of CPR quality in episodes of ER.

Setting

Three independent board-certified emergency physicians trained in CPR and the American Heart Association (AHA) guidelines reviewed ER episodes in two 5-year time-frames (2001–2005 and 2005–2009). Congruency with the corresponding 2000 and 2005 AHA guidelines was determined for each CPR scene.

Patients

None.

Interventions

None.

Main outcome measures

To evaluate whether CPR is in agreement with the specific algorithms of the AHA guidelines. Fisher's exact test and Mann–Whitney-U-test were used to evaluate statistical significance (P < 0.05).

Results

A total of 136 on-screen cardiac arrests occurred in 174 episodes. Trauma was the leading cause of cardiac arrest (56.6%), which was witnessed in 80.1%. Return of spontaneous circulation occurred in 38.2%. Altogether, 19.1% of patients survived until ICU admission, and 5.1% were discharged alive.

Conclusions

Only one CPR scene was in agreement with the published AHA guidelines. However, low-quality CPR and non-compliance with the guidelines resulted in favorable outcomes.     

A stabilization device to improve the quality of cardiopulmonary resuscitation during ambulance transportation: A randomized crossover trial

Background

The quality of cardiopulmonary resuscitation (CPR) during ambulance transportation is suboptimal, and therefore measures that can improve the quality are desirable.

Purpose

To evaluate whether the use of a stabilization device can improve the quality of CPR during ambulance transportation.

Methods

This randomized controlled crossover trial enrolled 22 experienced ambulance officers. Each participant performed CPR in an ambulance under three conditions with 72 h apart, each condition for 10 min: non-moving (NM), moving without device (MND), and moving with device (MD). The sequences of conditions were randomized. The primary outcomes were effective chest compressions recorded by the Laerdal Resusci-Anne Skill-reporter manikin. The secondary outcomes included the severity of back pain scored using the Brief Pain Inventory short-form, the physiology parameter before and after CPR, and the changes in postural stability which was represented by the sway index (SI) of lower back measured using a goniometer.

Results

The overall effective compressions in 10 min were 87.0 ± 17% for NM, 59.0 ± 19% for MND, and 69.0 ± 23% for MD (p < 0.001). Compared to MND, MD had a lower no-flow fraction while driving on curved sections (0.04 vs. 0.29, p < 0.001). Whereas the pain severity and social interference scores were similar under all conditions, MND had a higher SI than MD and NM.

Conclusions

The use of a stabilization device can improve the quality of CPR and posture stability during ambulance transportation, although the effects on the severity of back pain were not significant.     

Erythropoietin facilitates the return of spontaneous circulation and survival in victims of out-of-hospital cardiac arrest

Background

Erythropoietin activates potent protective mechanisms in non-hematopoietic tissues including the myocardium. In a rat model of ventricular fibrillation, erythropoietin preserved myocardial compliance enabling hemodynamically more effective CPR.

Objective

To investigate whether intravenous erythropoietin given within 2 min of physician-led CPR improves outcome from out-of-hospital cardiac arrest.

Methods

Erythropoietin (90,000 IU of beta-epoetin, n = 24) was compared prospectively with 0.9% NaCl (concurrent controls = 30) and retrospectively with a preceding group treated with similar protocol (matched controls = 48).

Results

Compared with concurrent controls, the erythropoietin group had higher rates of ICU admission (92% vs 50%, p = 0.004), return of spontaneous circulation (ROSC) (92% vs 53%, p = 0.006), 24-h survival (83% vs 47%, p = 0.008), and hospital survival (54% vs 20%, p = 0.011). However, after adjusting for pretreatment covariates only ICU admission and ROSC remained statistically significant. Compared with matched controls, the erythropoietin group had higher rates of ICU admission (92% vs 65%, p = 0.024) and 24-h survival (83% vs 52%, p = 0.014) with statistically insignificant higher ROSC (92% vs 71%, p = 0.060) and hospital survival (54% vs 31%, p = 0.063). However, after adjusting for pretreatment covariates all four outcomes were statistically significant. End-tidal PCO₂ (an estimate of blood flow during chest compression) was higher in the erythropoietin group.

Conclusions

Erythropoietin given during CPR facilitates ROSC, ICU admission, 24-h survival, and hospital survival. This effect was consistent with myocardial protection leading to hemodynamically more effective CPR (Trial registration: http://isrctn.org. Identifier: ISRCTN67856342).