Use of a Checklist During Observation of a Simulated Cardiac Arrest Scenario Does Not Improve Time to CPR and Defibrillation Over Observation Alone for Subsequent Scenarios

Theory: Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial. Hypotheses: The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone. Methods: Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers. Results: Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = –2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts. Conclusions: Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.     

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

AimTo determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR.MethodsFrom out-of-hospital cardiac arrest (OHCA) data prospectively collected from 2005 to 2011 in Japan, we extracted data for 210,134 bystander-witnessed OHCAs with complete datasets but no prehospital involvement of physician [no BCPR, 115,733; ventilation-only, 2093; compression-only, 61,075; and conventional (compressions+ventilations) BCPR, 31,233] and determined the factors associated with 1-month neurologically favourable survival using simple and multivariable logistic regression analyses. In 91,885 patients with known BCPR durations, we determined the factors associated with ventilation-only BCPR.ResultsThe rate of survival in the no BCPR, ventilation-only, compression-only and conventional group was 2.8%, 3.9%, 4.5% and 5.0%, respectively. After adjustment for other factors associated with outcomes, the survival rate in the ventilation-only group was higher than that in the no BCPR group (adjusted OR; 95% CI, 1.29; 1.01–1.63), but lower than that in the compression-only (0.76; 0.59–0.96) or conventional groups (0.70; 0.55–0.89). Conventional CPR had the highest OR for survival in almost all OHCA subgroups. The adjusted OR (95% CI) for survival after dividing BCPR into ventilation and compression components was 1.19 (1.11–1.27) and 1.60 (1.51–1.69), respectively. Older guidelines, female sex, younger patient age, bystander-initiated CPR without instruction, early BCPR and short BCPR duration were associated with ventilation-only BCPR.ConclusionsVentilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs.     

Association of the time to first epinephrine administration and outcomes in out-of-hospital cardiac arrest: SOS-KANTO 2012 study

Objective

This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.

泵式自体输血过滤引流系统在急症救护中的应用

自体输血、胸腔闭式引流，是缓解血源矛盾、赢得抢救时机、防治心肺衰竭及ＡＲＤＳ／ＭＯＦ的重要措施。笔者研制成功的手控泵式储血过滤引流系列在战地、灾害现场，以及平时的心肺手术中，共应用３０００余例，现重点对其功能设计和用于自体输血、紧急救护做讨论和评估。     

大剂量肾上腺素在心脏骤停抢救中的应用体会

目的探讨大剂量肾上腺素在心肺复苏中的应用情况。方法对2002年以来11例应用大剂量肾上腺素进行心肺复苏的病例做回顾性研究。结果在应用大剂量肾上腺素后心肺复苏成功率明显提高达73%。结论目前推荐的肾上腺素剂量(1mg)可能太小,不能使骤停的心脏都复跳,建议使用大剂量肾上腺素。     

BENEFICENCE,TEMPERANCE AND MEDICAL SCIENCE

John Coakley Lettsom (1744–1815) founded the Medical Society of London and played a key role in the development of the Royal Humane Society. His Quaker background underpinned his interest in social reform. He established dispensaries and soup kitchens for the poor, recognized the need for public health measures in the control of disease, and advocated prison reform and education of the poor.     

Abdominal Pumping

This article reviews the author's experience with a form of interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) in the United Kingdom. The development of the technique based upon animal resuscitation, including the use of phasic compression (abdominal pumping) for the resuscitation of rats from 30 minutes of cardiac arrest due to hypothermia, is reviewed. A simple technique for clinical use is described. The technique uses a hard-covered book or bean-shaped board applied to the abdomen below the umbilicus and compressed alternately with cardiac massage while respiration is assisted. Anecdotal clinical results suggest that further controlled clinical investigation is warranted.     

院前紧急气管插管与机械通气24例临床分析

目的总结紧急气管插管与机械通气在院前急救中应用的经验,以期提高院前急救水平。方法回顾性分析24例院前气管插管与机械通气抢救心搏呼吸骤停病人的临床资料。结果24例病人气管内插管均获成功,成功率100%。完成气管内插管的时间是15s～60s,平均时间(25±15)s。心搏、自主呼吸恢复4例(16.7%),心搏恢复8例(33.3%);心搏及自主呼吸均未恢复12例(50.0%)。结论气管插管与机械通气是急诊抢救危重病人的基础,对保证进一步心肺复苏、挽留手术机会以及提高危重患者抢救成功率有重要意义。要加强对抢救人员进行紧急气管插管和机械通气的培训。