Cardiopulmonary Resuscitation

Background-Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary endpoints. Methods-A subset of 1007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months following enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form (SF-36) psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales. Results-For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/

CARDIAC ARREST, or as it is more cor¬ rectly called, cardiopulmonary arrest, re¬ sulting from ventricular standstill or fibrilla- tion is an unpredictable complication in 8,000 to 10,000 surgical procedures performed in this country each year (1-3). Cardiopulmonary ar¬ rest is also the presumed cause of death in many of the 500,000 persons per year who die sud¬ denly from coronary artery disease (3-6). Proper application of current concepts of car¬ diopulmonary resuscitation may save many of those affected while in operating room areas (6, 7), and an estimated one-half to two-thirds of sudden coronary deaths may be ultimately avoided through prompt institution of therapy Cardiopulmonary arrest can result from a wide variety of circumstances including anoxia, drug toxicity or idiosyncrasy, and coronary oc- clusion. It is often a relatively transient phe¬ nomenon (9), occurring in hearts with an es¬ sentially intact myocardium (10); thus it has been stated that the heart needs only a second chance to survive (11). Cardiopulmonary arrest has been managed in the past by open-chest cardiac massage and direct application of electrical currents to the myocardium (6, 12, 13). Because of the spe¬ cial qualities of training and initiative required, however, to perform emergency thoracotomy and direct cardiac massage and the possibility of serious sequelae to such a vigorous procedure, efforts have been directed toward developing simpler techniques of stimulating and defibril- lating human hearts, such^as application of Dr. Schrogie is assistant chief of the Coronary Heart Disease Section, Heart Disease Control Branch, Di¬

Extracorporeal membrane oxygenation (ECMO) is a general term that describes the short-or long-term support of the heart and/or lungs in neonates, children and adults. Due to favorable results and a steady decline in absolute contraindications, its use is increasing worldwide. Indications in children differ from those in adults. The ECMO circuit as well as cannulation strategies also are individualized, considering their implications in children. The aim of this article is to review the clinical indications, different circuits, and cannulation strategies for ECMO. We also present our institutional experience with 92 pediatric ECMO patients (34 neonates, 58 pediatric) with the majority (80%) of veno-arterial placements between 2014 until 2018. We further to also highlight ECMO use in the setting of cardiac arrest [extracorporeal cardiopulmonary resuscitation (CPR) or eCPR].

Cardiac and vascular intervention in thrombocytopenic congenitally cyanotic patients is more dangerous. Thrombocytopenia in these patients is related to immune thrombocytopenia, polycythemia, hyperviscosity, pseudothrombocytopenia, and drugs. Herein we report on a thrombocytopenic 8-year-old girl with tricuspid valve atresia and pulmonary valve stenosis admitted for catheterization. Thrombocytopenia (21,000/mm3) and shunt occlusion was noticed. Thrombocytopenia did not recover after intravenous immunoglobulin (IVIG) and phlebotomy therapies. During preparation for surgery, she suffered cardiopulmonary arrest. A Gore-tex graft was placed in the right pulmonary artery and truncus brachiocephalicus. After surgery, her platelet count spontaneously increased to within the normal range (178,000/mm3 to 250,000/mm3). After resuscitation, she had right-sided hemiplegia sequelae, though there were no hemorrhagic findings on cranial magnetic resonance imaging (MRI) or computed tomography (CT) ...

A 2-year long, multisite research study that evaluated cardiopulmonary resuscitation skill decay among nursing students was conducted at 10 schools of nursing across the United States. The study was conducted in two phases and required carefully timed sessions for skill performance. Multisite studies in nursing education need to be carefully planned. Time delays should be anticipated with processes and Institutional Review Board protocols across sites. All team members were trained and consistently supported during the entire study. While challenges and obstacles were identified, innovative solutions were implemented that assisted the research team to successfully complete the study. The use of new and existing technology allowed the team to surmount many of the challenges encountered in this study. The purpose of this article is to describe the logistics, processes, challenges, and lessons learned related to conducting a complex multisite study.

Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE. Methodology/Principal Findings: We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.661.2 min versus 24.660.8 min; p,0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.061.3 vs. 22.560.9 min; p,0.001). Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.

Evaluation of Basic Life Support (BLS) videos published on YouTube O presente trabalho tratará de uma análise de vídeos do YouTube relacionada ao suporte básico de vida de acordo com as diretrizes da American HeartAssociation (AHA) de 2010. O trabalho em questão é uma pesquisa do tipo exploratória, com abordagem quantitativa, realizada no sítio de compartilhamento de vídeos do YouTube, cujo endereço é "www.youtube.com.br", um "site" bastante acionado pelos usuários da "internet" para adquirir conhecimentos de qualquer área. Foram analisados 104 vídeos. A média de duração dos vídeos foi de 6 minutos e 21 segundos. Dos 104 vídeos, 40 (38%) estavam de acordo com AHA e 64 (62%) não estavam conforme as diretrizes AHA. Quanto ao número de erros por vídeos os resultados demonstraram que metade dos vídeos analisados apresentaram 3 erros de publicação de acordo com AHA de 2010. Os vídeos analisados perfizeram um total de 148 desconformidades. O não seguimento da sequência CABD foi o erro mais comum observado com 45 (30,4%) aparições. Em relação à autoria dos vídeos, estes foram publicados por organização/instituição, pessoa física e ONG. Os vídeos analisados apresentaram um grande número de visualizações obtendo uma média de 23.829 visualizações. This research will deal with an analysis of YouTube videos related to basic life support according to the guidelines of the American Heart Association (AHA) 2010. These is an exploratory research with a quantitative approach, carried out at the site of sharing YouTube videos, whose address is "www.youtube.com.br " a " site " that is very driven by users ' internet " to acquire knowledge in any field . 104 videos were analyzed. The average length of the videos were 6 minutes and 21 seconds. Of the 104 videos analyzed, 40 ( 38 % ) were in accordance with AHA and 64 ( 62 % ) were not in accordance with guidelines AHA . As for the number of errors per video results showed that half of the videos analyzed present 3 Mistakes of publication according to AHA 2010. Videos analyzed resulted in a total of 148 discontinuities in total. Failure to follow the sequence CABD was the most common error observed in 45 (30.4%) appearances. Regarding the authorship of the videos were posted by the same organization / institution, individuals and NGOs. The videos analyzed showed a large number of views getting an average of 23,829 views

The internet is a widely used source for obtaining medical information both by patients and physicians. YouTube is an essential source of information that may be a useful tool to inform the public and may improve the learning experience if used adequately. In this study, we aimed to estimate the quality and accuracy of videos about cardiopulmonary resuscitation videos aired on YouTube, which is the most popular video platform of the online world. Methods: We included the first 100 videos, in English, returned by the YouTube search engine in response to "cardiopulmonary resuscitation" keyword query to the study. The popularity of the videos was evaluated with an index called the video power index. The educational quality, accuracy, and transparency of the visual content were measured using the DISCERN questionnaire (DISCERN), Journal of American Medical Association (JAMA-BC) benchmark criteria, and Global Quality Score (GQS). The technical quality was measured by the Cardiopulmonary Resuscitation Scoring System (CPR-SS), which was utilized by three bariatric surgeons. Results: The source in 7% of the videos was medical doctors. The content in 89% of the videos was cardiopulmonary resuscitation technique. According to sources, videos uploaded by physicians had significantly higher quality, transparency, educational and technical value. Unlike, videos uploaded by physicians had a lower video power index than videos uploaded by non-medical professionals. Cardiopulmonary resuscitation technique videos had significantly higher quality, transparency, educational and technical value. Cardiopulmonary resuscitation technique videos also had higher popularity scores than "information or lecture" videos. Also, negative correlations were found between the (popularity index and transparency, education and technical quality scores. Conclusions: Online information on cardiopulmonary resuscitation is of low quality, and its contents are of unknown source and accuracy. However, the educational potential of the online video platform, YouTube, cannot be neglected.

Resuscitation clinical care plans (resuscitation plans) are gradually replacing 'Not for Cardiopulmonary Resuscitation' orders in the hospital setting. The 7-Step Pathway Resuscitation Plan and Alert form (7-Step form) is one example of a resuscitation plan. Treatment recommendations in resuscitation plans currently lack standardised language, creating potential for misinterpretation and patient harm. To explore how terminology used in resuscitation plans is interpreted and applied by clinicians. A mixed methods study surveyed 50 general medical doctors, who were required to interpret and apply a 7-Step form in three case vignettes and define seven key terms. Statistical analysis on multiple choice and thematic analysis on free-text responses was performed. Terminology was inconsistently interpreted and inconsistently applied, resulting in clinically significant differences in treatment choices. Three key themes influenced the application of a resuscitation plan: in-depth discussion, precise documentation and personal experience of the bedside deciding doctor.

OBJECTIVES: this study was aimed at developing and validating a checklist of preoperative pediatric interventions related to the safety of surgical patients. METHOD: methodological study concerning the construction and validation of an instrument with safe preoperative care indicators. The checklist was subject to validation through the Delphi technique, establishing a consensus level of 80%. RESULTS: five professional specialists in the area conducted the validation and a consensus on the content and the construct was reached after two applications of the Delphi technique. CONCLUSION: the "Safe Pediatric Surgery Checklist", simulating the preoperative trajectory of children, is an instrument capable of contributing to the preparation and promotion of safe surgery, as it identifies the presence or absence of measures required to promote patient safety.

Background: The effect of intravenous fluid (IVF) administration during cardiopulmonary resuscitation (CPR) is an unexplored factor that may improve cardiac output (CO) during CPR. The aim of this study was to determine the effect of IVF administration on CO and oxygenation during CPR. Methods: This experimental animal study was performed in a critical care animal laboratory. Twenty-two Landrace-Yorkshire female piglets weighing 27-37 kg were anesthetized, intubated, and placed on positive pressure ventilation. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into IVF or no-IVF groups. Pigs in the IVF group were given 20 mL/kg of Plasma-Lyte (Baxter International, Deerfield, IL USA), infused from 15 to 35 min of CPR. CPR was maintained for 50 min with serial measurements of CO obtained using ultrasound dilution technology and partial pressure of oxygen (PaO 2 ). Results: A mixed-effects repeated measures analysis of variance was used to compare within-group, and between-group mean changes in CO and PaO 2 over time. CO and PaO 2 for the piglets were measured at 10-min intervals during the 50 min of CPR. CO was greater in the IVF compared with the control group at all time points during and after the infusion of the IVF. Mean PaO 2 decreased with time; however, at no time was there a significant difference in PaO 2 between the IVF and control groups. Conclusions: Administration of IVF during CPR resulted in a significant increase in CO during CPR both during and after the IVF infusion. There was no statistically significant decrease in PaO 2 between the IVF and control groups.

Pandemic COVID-19 has a bruthless strength which highly emphasize of all dimension in human life. It made a high turnover in all approach to achieve a better way to minimize the catastrophe. In emergency response the approach for cardiopulmonary arrest are highly debate for ethics and better prognosis and the utmost is safety for medical personnel. COVID-19 is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is highly contagious. Out of Hospital Cardiac Arrest (OHCA) from French Registry (French National Cardiac Arrest Registry) between march 1st and april 31st 2020 revealed ROSC rate was reduction by six point (ROSC 19.5% vs 25.3%) and D30 survival rate (2.8% vs 6.4%) was halved compared to non COVID 19 period. In the regards of in-hospital cardiac arrest (IHCA) during pandemic, COVID 19 accounts for 16% of IHCA and increased in 30 day mortality 2.3 folds; odd ratio compared with non COVID-19 was 2.27% and adjusted 30day survival were 23.1% in COVID 19, 39.5% in non COVID-19 compared with 36.4% in pre pandemic period. Health workers are the profession with the highest risk of contracting this disease. Resuscitation efforts increase the risk of transmission to health workers for a variety of reasons. To address the issues ILCOR, AHA and ERC have several changes from the recent guideline to confront resuscitation in COVID 19.

O Ob bj je ec ct ti iv ve es s: : Acute renal failure (ARF) is a common complication following open heart surgery especially in infants. Effects of blood viscosity on renal function are well known, but have not been investigated in cardiopulmonary bypass (CPS) as yet. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : We investigated blood viscosity and different markers of glomerular and tubular renal function in a group of 37 infants below 18 month of age, receiving CPS surgery for different diagnoses. In an experimental setting, we investigated 28 isolated pig-kidneys with different hematocrits in an autologous blood perfused model. R Re es su ul lt ts s: : In infants, creatinine clearance decreased and urinary excretion of albumin and β-NAG increased during the aortic cross clamp time (AT) and during the first hours following operation, indicating moderate glomerular and tubular damage. During AT, blood was hemodiluted to a hemoglobin of 8.4 ± 0.4 g/dl. Thus, blood viscosity during AT and hypothermia was slightly below pre-CPB values. Lower blood viscosity was related to less renal damage (P < 0.01). In isolated pig-kidneys, group I (n = 14) was perfused with a hemoglobin of 10.2 ± 0.3 g/dl and group II (n = 14) was hemodiluted to 6.5 ± 0.9 g/dl. Group II kidneys showed lower vascular resistance, elevated creatinine clearance, elevated oxygen consumption and elevated sodium reabsorption (P < 0.05). C Co on nc cl lu us si io on ns s: : Reducing blood viscosity below physiological values improves tubular as well as glomerular function under CPB conditions. Thus we hold hemodilution to be an appropriate method for optimizing CPB procedures.

O Ob bj je ec ct ti iv ve es s: : Acute renal failure (ARF) is a common complication following open heart surgery especially in infants. Effects of blood viscosity on renal function are well known, but have not been investigated in cardiopulmonary bypass (CPS) as yet. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : We investigated blood viscosity and different markers of glomerular and tubular renal function in a group of 37 infants below 18 month of age, receiving CPS surgery for different diagnoses. In an experimental setting, we investigated 28 isolated pig-kidneys with different hematocrits in an autologous blood perfused model. R Re es su ul lt ts s: : In infants, creatinine clearance decreased and urinary excretion of albumin and β-NAG increased during the aortic cross clamp time (AT) and during the first hours following operation, indicating moderate glomerular and tubular damage. During AT, blood was hemodiluted to a hemoglobin of 8.4 ± 0.4 g/dl. Thus, blood viscosity during AT and hypothermia was slightly below pre-CPB values. Lower blood viscosity was related to less renal damage (P < 0.01). In isolated pig-kidneys, group I (n = 14) was perfused with a hemoglobin of 10.2 ± 0.3 g/dl and group II (n = 14) was hemodiluted to 6.5 ± 0.9 g/dl. Group II kidneys showed lower vascular resistance, elevated creatinine clearance, elevated oxygen consumption and elevated sodium reabsorption (P < 0.05). C Co on nc cl lu us si io on ns s: : Reducing blood viscosity below physiological values improves tubular as well as glomerular function under CPB conditions. Thus we hold hemodilution to be an appropriate method for optimizing CPB procedures.

There exists variation in respiratory care for the management of preterm babies. Although surfactant has been used in India since the early 90s, there is no data on the current Indian practices. This study was undertaken with the objective to identify the different practices currently in various tertiary Neonatal Intensive Care Unit (NICUs) and non-tertiary neonatal services across the country. Method: The survey was conducted by administering a structured questionnaire on neonatal respiratory care and surfactant administration in very preterm infants among Indian NICUs in Tier I, Tier II & Tier Ill cities. Results: We report data from 65 centres across India. Data on ventilator practices and surfactant administration is outlined. Conclusions: There exists a striking difference between centres with respect to the approach and management of preterm infants with respiratory distress. More such surveys are needed on various aspects so that required measures can be taken to optimize clinically meaningful neonatal outcomes across country.

Objectives: to explain succinctly the responsibility of primary care within the mental health and propose a flowchart of service generally to that work and are in need of mental health services. Method: descriptive study conducted through integrative literature review, using scientific publications available in the databases LILACS, Medline and BDENF, between the years 2006 to 2012, with final sample 18 articles. Results: the integration of the principles of psychiatric reform with the Sistema Único de Saúde (SUS) Brazil's are indispensable tools in the care to the carrier of psychic suffering. This takes place through the psychosocial model, integrality of attention, social participation, territoriality and collective actions, which work effectively when there are professional preparation for working with this demand and support of the community. Conclusion: therefore, we realized that all these actions can only be reached through a larger view/holistic psychic suffering carrier and through the establishment of a network of integrated mental health with primary health care. Descriptors: Primary Health Care; Mental Health; The family health program. Objetivos: explanar de forma sucinta a responsabilidade da atenção básica no âmbito da saúde mental e propor um fluxograma de atendimento de forma generalizada aos que trabalham e necessitam dos serviços de saúde mental. Método: estudo descritivo realizado por meio de revisão integrativa da literatura, utilizando publicações científicas disponibilizadas nas bases de dados LILACS, Medline e BDENF, entre os anos de 2006 a 2012, tendo como amostra final 18 artigos. Resultados: a integração dos princípios da Reforma Psiquiátrica com o Sistema Único de Saúde do Brasil (SUS) são ferramentas indispensáveis no cuidado ao portador de sofrimento psíquico. Este se dá através do modelo psicossocial, integralidade da atenção, participação social, territorialidade e ações coletivas, que funcionam efetivamente quando se há preparo profissional para trabalhar com esta demanda e apoio da comunidade. Conclusão: logo, percebemos que todas estas ações só poderão ser alcançadas através de uma visão ampliada/holística do portador de sofrimento psíquico e através da constituição de uma rede de saúde mental integrada com a atenção básica. Descritores: Atenção Primária; Saúde Mental; Programa Saúde da Família.. Objetivos: explicar de forma sucinta la responsabilidad de la atención básica en el ámbito de la salud mental y proponer un flujograma de atendimiento de forma generalizada a los que trabajan y necesitan de los servicios de salud mental. Método: estudio descriptivo realizado por medio de revisión integrativa de la literatura, utilizando publicaciones científicas disponibles en las bases de datos LILACS, Medline y BDENF, entre los años de 2006 a 2012, teniendo como muestra final 18 artículos. Resultados: la integración de los principios de la Reforma Psiquiátrica con el Sistema Único de Salud de Brasil (SUS) son herramientas indispensables en el cuidado al portador de sufrimiento psíquico. Este se da a través del modelo psicosocial, integralidad de la atención, participación social, territorialidad y acciones colectivas, que funcionan efectivamente cuando se tiene preparo profesional para trabajar con esta demanda y apoyo de la comunidad. Conclusión: luego, percibimos que todas estas acciones solamente podrán ser alcanzadas a través de una visión ampliada/holística del portador de sufrimiento psíquico y a través de la constitución de una red de salud mental integrada con la atención básica.

Context. The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19. Objectives. Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measuresonly orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19. Methods. This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death. Results. We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5-2.19; 1.78, 1.15-3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35-2.32), and male sex (OR 1.16, CI 1.0-1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort

In the previous and the current guidelines of the European Resuscitation Council (ERC), endotracheal intubation (ETI), as an instrument for ventilation during resuscitation, was confirmed as less important for paramedics not trained in this method. For those, during resuscitation, the laryngeal tube is recommended by the ERC as a supraglottic airway device. The present study investigated prospectively the use of the laryngeal tube disposable (LT-D) by paramedics in prehospital emergency cases. Methods During a 42-month period (Sept 2008-Feb 2012), we prospectively registered all prehospital cardiac arrest situations in which the LT-D had been applied by paramedics (from one emergency medical service in Germany). Results During the defined period, 133 attempts, recorded on standardised data sheets, were enrolled into the investigation. Three were excluded from the study because of use during a trauma situation. Therefore, 130 patients were evaluated in this study. For this, the LT-D was used in 98% of all cases during resuscitation, and in about 2% of other emergencies (eg, trauma). With regard to resuscitation, adequate ventilation/oxygenation was described as possible in 83% of all included cases. In 66% of all cases, no problems concerning the insertion of the LT-D were described by the paramedics. No significant problems were reported in 93%. In 7% (n=9 cases), no insertion of the LT-D was possible. Instead of bag-mask-valve ventilation, the LT-D was used as a first-line airway device in about 66%. Between the two defined groups, no statistically significant differences were found ( p>0.05). Conclusions As an alternative airway device during resuscitation, recommended by the ERC in 2005 and 2010, the LT-D may enable ventilation rapidly and, as in most of our described cases, effectively. Additionally, by using the LT-D in a case of cardiac arrest, a reduced 'hands-off time' and, therefore, a high chest compression rate may be possible. Our investigation showed that the LT-D was often used as an alternative to bag-mask-ventilation and to ETI as well. However, we were able to describe more problems in the use of the LT-D than earlier investigations. Therefore, in future, more studies concerning the use of alternative airway devices in comparison with ETI and/or videolaryngoscopy seem to be necessary.

Purpose: "KIDS SAVE LIVES" is a suggested training program by European Resuscitation Council (ERC) and aims to educate all children in First Aid. We aimed to present the results of KIDS SAVE LIVES training program for the period 2016-2019. Methods: The Humanitarian Organisation "KIDS SAVE LIVES -T␣ ␣␦ ␣ о Z έ" and the Hellenic Society of Emergency Prehospital Care set up a plan for establishing mandatory education of schoolchildren over 10 years old in CPR. Having the approval of Greek Ministry of Education, the aforementioned Organisations implemented CPR training in primary and secondary schools. Results: After 4 years of KIDS SAVE LIVES initiation in Greece, 53,793 schoolchildren ≥10 yrs, teachers, and parents were trained in 559 schools (46,217, 6681 and 895 accordingly). Today, Greece is the country with the youngest certified Instructors in Europe (100 BLS Provider and Instructor courses in schools). 18 victims of OHCA resuscitated by trained bystanders and Nefeli, is the first child that resuscitated an OHCA victim; 6 volunteers resuscitated 12 choking victims. Moreover, the program has been achieved the establishment of 140 public AEDs, the creation of an application with the location of 442 AEDs, the national school CPR championship, the Virtual Reality-CPR training, and online lessons of students due to COVID-19 prevention measures. The official law proposal for the establishment of CPR training as a basic school subject has already applied to the Ministry of Education. The pilot phase is expected to begin in September of 2020 with the initiation of CPR lessons by teachers who have been trained by our program. Conclusion: KIDS SAVE LIVES course is a successful method for mass training events. Incorporating training into the mandatory education syllabus, will facilitate the formation of a pool of young promising rescuers and contributing so to the future improvement of survival after OHCA.

Summary. Various clinical parameters, neurological examination models, biochemical tests, electrophysiological procedures and neuro-imaging techniques have been studied with respect to the detection of cerebral hypoxia in patients after cardiopulmonary resuscitation. These parameters were critically evaluated by the members of the Austrian interdisciplinary consensus conference. Based on the results of scientific publications, the consensus meeting identified 26 parameters, which allow the prognostic evaluation of cerebral hypoxia after cardiopulmonary resuscitation. Among these parameters, however, the strength of evidence and the level of recommendation are different.

Background: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS). Methods/Design: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed. Discussion: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe. Trial registration: The EuReCa ONE Study is registered by ClinicalTrials.gov National CoordinatorT02236819).

Background and aim of the study: Arterial lines are widely used in operating rooms, critical care and emergency departments. Although invasive arterial blood pressure monitoring and arterial blood gas analysis are prehospitally available, the use of arterial lines in the field remains an exception. This study evaluates the feasibility, indications and therapeutic consequences of prehospital arterial line insertion. Methods: Prospective observational study in four physician-staffed emergency medical systems (EMS), documenting patient status, indications, location of puncture, number of tries and time for puncture and therapeutic consequences. Results: During the one-year observation period, arterial line placement succeeded in 115 (83.9%) of 137 patients. The median time for successful arterial cannulation was 2 min (IQR 1, 3 min; range: 30-600 s), for preparing the invasive blood pressure monitoring 3 min (IQR 2, 4 min, range: 30-600 s). Main indications were cardiopulmonary resuscitation (36.5%), post-resuscitation care (16.8%), respiratory insufficiency (24.1%) and unconsciousness (22.6%). Therapeutic consequences depended on whether the EMS was equipped with a blood gas analyzer or not and were, overall, reported in 51.3% of patients: fluids, vasoactive or antihypertensive therapy, correction of ventilation or acidosis. No complications occurred during the prehospital phase. The insertion of arterial lines is feasible under prehospital conditions, without delaying or complicating patient care. Indications originating from intrahospital use are also valid in the field. In particular when combined with arterial blood gas measurement, the use of arterial lines often leads to important therapeutic consequences.

The recognition of the ethical and legal appropriateness of withholding or withdrawing life-sustaining medical treatment is now ingrained as an essential part of the medical decision making process in end-of-life and palliative care. Just a generation ago, however, it was less clear. At that time, as a result of new technologies, such as cardiopulmonary resuscitation, ventilation, and nutrition and hydration, physicians were able to prolong patients' lives beyond previous limits. The paradigm case was that of a patient who was permanently unconscious and dependent on continued artificial ventilation. Medical professionals faced a new set of ethical and legal questions: Under what circumstances, if any, may one stop life-sustaining medical treatment? Must medical measures that were initiated to sustain life be continued until the patient's death? What role should the patient's wishes play? Is withholding or withdrawing life-sustaining medical treatment a form of homicide or suicide? Ethicists, legal professionals, and medical practitioners are still struggling for answers and a consensus to many of these questions. The crux of the problem was this: If the expected result of intentionally withdrawing a life-sustaining medical treatment (such as a ventilator) was death, was not this act of withdrawal an intentional cause of the patient's death just as surely as if the physician had ended the patient's life by lethal injection? Philosophers and theologians analyzed this question in different ways. The theological approaches included those of the Roman Catholic tradition that differentiate ordinary care, which is obligatory, from extraordinary care, which may be discontinued. Factors to be considered in determining if a treatment is extraordinary include the gravity of the burdens of that treatment to the patient or

Introduction Both out of (OHCA) and in hospital (IHCA) pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. This is further magnified by resuscitation protocols are typically articulated from the perspective of ideal resource environment without consideration of applicability in district hospitals or non-tertiary centres. Purpose To determine clinical outcomes from both paediatric OHCA and IHCA in low-resource setting and to identify shortcomings in relation to resuscitation in these areas, possible solutions and to suggest future research priorities. Methods This was a multicenter retrospective study in a middle sized city (estimated population 390000) served by a single Emergency Medical Services (EMS) system. All records of OHCA and IHCA under 16 years old were reviewed from the Cardiac Arrest Registry from 2017 to 2022. Data collected included demographic profiles, etiology of cardiac arrest, initial cardiac rhythm, time of ...

Aims: Our goals were to describe and analyse the medical management and clinical course of avalanche victims in cardiac arrest (CA), focusing on adherence to international recommendations on avalanche victims in CA regarding critical decisions. We retrospectively included all avalanche victims with CA from 1st January 2004 to 1st June 2016 in a single physician-staffed alpine helicopter emergency medical service. Data regarding cardiopulmonary resuscitation (CPR), transportation to hospital whilst undergoing CPR, and extracorporeal life support rewarming (ECLSR) for patients still in CA at hospital admission were abstracted from the prehospital and medical health records. Results: Sixty-six victims were included in this study; 31 (47%) were declared dead on scene. Of the remaining 35 victims, 7 (20%) had prehospital return of spontaneous circulation (ROSC), 28 (80%) were transported whilst undergoing CPR, 3 had hospital ROSC and 7 (28%) of the 25 patients with persistent CA at hospital underwent ECLSR. The medical management comprised 126 documented critical decisions, corresponding to guidelines in 117 (93%) decisions. None of the 66 studied patients survived to hospital discharge, and 7 (11%) were organ donors. The management of avalanche victims in CA respect current guidelines regarding the critical decisions, but no patient survived in this sample. The presence of a few cases with incorrect management and potential undertreatment suggests some room for improvement.

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature &lt; 30 °C in young and healthy patients and &lt;32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure &lt; 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient a...

Aims: Our goals were to describe and analyse the medical management and clinical course of avalanche victims in cardiac arrest (CA), focusing on adherence to international recommendations on avalanche victims in CA regarding critical decisions. We retrospectively included all avalanche victims with CA from 1st January 2004 to 1st June 2016 in a single physician-staffed alpine helicopter emergency medical service. Data regarding cardiopulmonary resuscitation (CPR), transportation to hospital whilst undergoing CPR, and extracorporeal life support rewarming (ECLSR) for patients still in CA at hospital admission were abstracted from the prehospital and medical health records. Results: Sixty-six victims were included in this study; 31 (47%) were declared dead on scene. Of the remaining 35 victims, 7 (20%) had prehospital return of spontaneous circulation (ROSC), 28 (80%) were transported whilst undergoing CPR, 3 had hospital ROSC and 7 (28%) of the 25 patients with persistent CA at hospital underwent ECLSR. The medical management comprised 126 documented critical decisions, corresponding to guidelines in 117 (93%) decisions. None of the 66 studied patients survived to hospital discharge, and 7 (11%) were organ donors. The management of avalanche victims in CA respect current guidelines regarding the critical decisions, but no patient survived in this sample. The presence of a few cases with incorrect management and potential undertreatment suggests some room for improvement.

Background: End tidal carbon dioxide (ETCO 2 ) monitoring during advanced life support (ALS) using capnography, is recommended in the latest international guidelines. However, several factors might complicate capnography interpretation during ALS. How the cause of cardiac arrest, initial rhythm, bystander cardiopulmonary resuscitation (CPR) and time impact on the ETCO 2 values are not completely clear. Thus, we wanted to explore this in out-of-hospital cardiac arrested (OHCA) patients. Methods: The study was carried out by the

The use of capnography is recommended during resuscitation. By implementing the mnemonic "PQRST", rescuers have a ready-made checklist to help them achieve the full potential of capnography. This approach can facilitate efforts to both reduce the hands-off time and individualize the treatment, which can lead to improved survival for our patients.

The use of capnography is recommended during resuscitation. By implementing the mnemonic "PQRST", rescuers have a ready-made checklist to help them achieve the full potential of capnography. This approach can facilitate efforts to both reduce the hands-off time and individualize the treatment, which can lead to improved survival for our patients.

Aim of the study: Prognostication may be difficult in comatose cardiac arrest survivors. Magnetic resonance imaging (MRI) is potentially useful in the prediction of neurological outcome, and it may detect acute ischemia at an early stage. In a pilot setting we determined the prevalence and development of cerebral ischemia using serial MRI examinations and neurological assessment. Methods: Ten witnessed out-of-hospital cardiac arrest patients were included. MRI was carried out approximately 2 h after admission to the hospital, repeated after 24 h of therapeutic hypothermia and 96 h after the arrest. The images were assessed for development of acute ischemic lesions. Neurophysiological and cognitive tests as well as a self-reported quality-of-life questionnaire, Short Form-36 (SF-36), were administered minimum 12 months after discharge. Results: None of the patients had acute cerebral ischemia on MRI at admission. Three patients developed ischemic lesions after therapeutic hypothermia. There was a change in the apparent diffusion coefficient, which significantly correlated with the temperature (p < 0.001). The neurophysiological tests appeared normal. The patients scored significantly better on SF 36 than the controls as regards both bodily pain (p = 0.023) and mental health (p = 0.016). Conclusions: MRI performed in an early phase after cardiac arrest has limitations, as MRI performed after 24 and 96 h revealed ischemic lesions not detectable on admission. ADC was related to the core temperature, and not to the volume distributed intravenously. Follow-up neurophysiologic tests and self-reported quality of life were good.

Background: The aim of this study was to investigate the influence of mild therapeutic hypothermia (MTH) on the incidence of and recovery from acute kidney injury (AKI). Methods: Patients who had undergone successful cardiopulmonary resuscitation (CPR) were included. Serum creatinine and cystatin C were measured at baseline, daily up to 5 days and at ICU discharge. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. MTH was applied for 24 h targeting a temperature of 33 °C. Neurological outcome was assessed with the Cerebral Performance Categories score at hospital discharge. Results: 126 patients were included in the study; 73 patients (58%) developed AKI. Patients treated with MTH had a significantly lower incidence of AKI as compared to normothermia (NT) (44 vs. 69%; p = 0.004). Patients with less favourable neurological outcomes had a significantly higher rate of AKI, although when treated with MTH the occurrence of AKI was reduced (50 vs. 80%; p = 0.017). Furthermore, MTH treatment was accompanied by significantly lower creatinine levels on day 0-1 and at ICU discharge (day 0: 1.12 (0.90-1.29) vs. 1.29 (1.00-1.52) mg/dl; p = 0.016) and lower cystatin C levels on day 0-3 and at ICU discharge (day 0: 0.88 (0.77-1.10) vs. 1.29 (1.06-2.16) mg/l; p < 0.001). Conclusions: Mild therapeutic hypothermia seems to have a protective effect against the development of AKI and on renal recovery. This may be less pronounced in patients with a favourable neurological outcome.

Summary Background There are conflicting results concerning sex-specific differences in the post-cardiac arrest period. We investigated the sex distribution of patients after successful cardiopulmonary resuscitation (CPR), differences in treatment, complications, outcome and sex-specific performance of biomarkers for prognostication of neurological outcome. Methods Prospective observational study including cardiac-arrest (CA) patients treated with mild therapeutic hypothermia (MTH) at 33 °C for 24 h or normothermia. We investigated common complications including pneumonia and acute kidney injury (AKI) and neuron-specific enolase, secretoneurin and tau protein as biomarkers of neurological outcome, which was assessed with the cerebral performance categories score at hospital discharge. Results Out of 134 patients 26% were female. Women were significantly older (73 years, interquartile range (IQR) 56–79 years vs. 62 years, IQR 53–70 years; p = 0.038), whereas men showed a significantl...

Background: The aim of this study was to investigate the influence of mild therapeutic hypothermia (MTH) on the incidence of and recovery from acute kidney injury (AKI). Methods: Patients who had undergone successful cardiopulmonary resuscitation (CPR) were included. Serum creatinine and cystatin C were measured at baseline, daily up to 5 days and at ICU discharge. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. MTH was applied for 24 h targeting a temperature of 33 °C. Neurological outcome was assessed with the Cerebral Performance Categories score at hospital discharge. Results: 126 patients were included in the study; 73 patients (58%) developed AKI. Patients treated with MTH had a significantly lower incidence of AKI as compared to normothermia (NT) (44 vs. 69%; p = 0.004). Patients with less favourable neurological outcomes had a significantly higher rate of AKI, although when treated with MTH the occurrence of AKI was reduced (50 vs. 80%; p = 0.017). Furthermore, MTH treatment was accompanied by significantly lower creatinine levels on day 0-1 and at ICU discharge (day 0: 1.12 (0.90-1.29) vs. 1.29 (1.00-1.52) mg/dl; p = 0.016) and lower cystatin C levels on day 0-3 and at ICU discharge (day 0: 0.88 (0.77-1.10) vs. 1.29 (1.06-2.16) mg/l; p < 0.001). Conclusions: Mild therapeutic hypothermia seems to have a protective effect against the development of AKI and on renal recovery. This may be less pronounced in patients with a favourable neurological outcome.

Take home message: The neuropeptide secretoneurin is a biomarker for hypoxic brain injury which is rapidly released in the first 24 h after cardiopulmonary resuscitation. Owing to its specific kinetics and properties, secretoneurin may significantly improve prediction of neurological outcome in combination with the existing marker neuron-specific enolase. Further studies in the context of SN and CPR are warranted to confirm these results.

The duration of cardiopulmonary resuscitation (CPR) affects neurological outcomes. Conclusive data on its decremental effect on neurological outcomes have not been explored before in a quantitative review. PubMed and Google Scholar were searched for relevant studies from 2015 up to May 2023 using relevant keywords. The odds of good neurological outcomes were studied. Binary random effects were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). A leave-one-out sensitivity analysis was performed. Heterogeneity was assessed using I 2 statistics. For outcomes showing moderate to high heterogeneity, subgroup analysis was performed for follow-up duration or type of study. A p value of < 0.05 was considered statistically significant. A total of 349,027 cardiac arrest patients (mean age, 70.2 years; males, 56.6%) from four studies were included in the meta-analysis. Of them, the initial rhythm was shockable in 11% (38,465/349,027) and non-shockable in 88.97% (310,562/349,027) of the population. Odds of having favorable neurological outcomes were 0.32 (95% CI 0.10-1.01, p = 0.05) for 6-10 min (n = 14,118), 0.10 (95% CI 0.02-0.64, p = 0.02) for 11-15 min (n = 43,885), 0.05 (95% CI 0.01-0.36, p 0.01) for 16-20 min (n = 66,174), 0.04 (95% CI 0.01-0.21, p < 0.01) for > 20 min (n = 181,262), and 0.03 (95% CI 0.00-1.55, p = 0.08) for > 30 min (n = 66,461) when compared to patients receiving CPR for < 5 min (n = 6420). Steady decremental odds of favorable neurological outcomes were seen with every 5 min of increased CPR duration, with a statistically significant decline seen in CPR duration from 11 to 15 min onwards.

ObjectiveTo evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about aerosol-spread is vital during the SARS-CoV-2-Pandemic.MethodsTo evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-spread during chest compressions the same way. We did recordings with undergoing compression-only-CPR, with a surgical mask and with an inserted laryngeal tube with and without a connected airway filter.ResultsMost aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask deflected the spread. Inserting a laryngeal tube connected to an airway filter lead to a remarkable reduction of aerosol-spread.ConclusionTh...

Background: Cardiac arrest is an emergency condition among the people in the hospitals as well as out-of-hospitals in the community. Bystander's plays a pivotal role in the early management of cardiac arrest by performing cardio pulmonary resuscitation. The present study was aimed to improve the cardiopulmonary resuscitation (CPR) skills through structured teaching programme (STP) among students of senior secondary school. Materials & Methods: Evaluative approach and pre-experimental one group pre-test post-test design was adopted for this study followed by STP on CPR skills. Using a probability sampling, simple random sampling technique was used to select students of age 12-18 years from urban senior secondary schools of Udaipur. The data was collected, tabulated, and analyzed using descriptive and inferential values by IBM statistical package for social sciences (SPSS; version 23) software. Results: The mean SD of the knowledge score of pre-test was 6.89±2.89 whereas mean SD of the post-test knowledge score was 15.08±2.43. The mean SD of the Practice score of pre-test was 3.40±1.45 whereas the mean SD of the Practice score of post-test was 7.28±1.71. There was a positive correlation (r-0.58) between the knowledge and Practice score. There was a significant association between Practice score and the occupation of the father of the students. Conclusions: It was observed that the increasing the number of trained school students can play pivotal role as a bystander with the victims of sudden cardiopulmonary collapse in the community to provide CPR. So, the STP and demonstration using manikin on CPR skills among school going students of urban senior secondary school is effective to enhance their knowledge and Practice score related to CPR and increase the positive outcomes.

Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest. The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon tes...

The need for rescue breathing during the initial management of sudden cardiac arrest is currently being debated and reevaluated. The present study was designed to compare cerebral oxygen delivery during basic life support (BLS) by chest compressions only with chest compressions plus ventilation in pigs with an obstructed airway mimicked by a valve hindering passive inhalation. Resuscitability was then studied during the subsequent advanced life support (ALS) period. After 3 min of untreated ventricular fibrillation (VF) BLS was started. The animals were randomised into two groups. One group received chest compressions only. The other group received ventilations and chest compressions with a ratio of 2:30. A gas mixture of 17% oxygen and 4% carbon dioxide was used for ventilation during BLS. After 10 min of BLS, ALS was provided. All six pigs ventilated during BLS attained a return of spontaneous circulation (ROSC) within the first 2 min of advanced cardiopulmonary resuscitation (CPR) compared with only one of six compressions-only pigs. While all except one compressions-only animal achieved ROSC before the experiment was terminated, the median time to ROSC was shorter in the ventilated group. With a ventilation:compression ratio of 2:30 the arterial oxygen content stayed at 2/3 of normal, but with compressions-only, the arterial blood was virtually desaturated with no arterio-venous oxygen difference within 1.5-2 min. Haemodynamic data did not differ between the groups. In this model of very ideal BLS, ventilation improved arterial oxygenation and the median time to ROSC was shorter. We believe that in cardiac arrest with an obstructed airway, pulmonary ventilation should still be strongly recommended.