Comparison of Termination-of-Resuscitation Guidelines for Basic Life Support: Defibrillator Providers in Out-of-Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest is an important cause that leads to hospital admission and death. Improving lay people’s knowledge and skills in basic life support (BLS) may lead to reduced death associated with out-of-hospital cardiac arrest. “BLS NU KKU” is a BLS training program developed from up-to-date literature as a smartphone application used to train lay people in the community. Objective: To evaluate BLS-related knowledge and skills of participants before and after BLS training. Materials and Methods: A one group pretest-posttest design was used to implement the present study in Khon Kaen, Thailand. Participants were 350 individuals age 18 and older. An 8-hour BLS training session was offered to 10 groups of 35 participants over the period of 10 months between November 2018 and August 2019. Self-administered questionnaires were used to assess BLS knowledge and Cardiopulmonary resuscitation (CPR) skills. Results: The mean score for BLS-related knowledge significantly increased after the BLS training (mean = 15.05, SD = 2.51) compared to the scores before the training (mean = 10.47, SD = 3.43) (p<0.05). BLS skills improved from 0% to 100% (p<0.001) will all skills rated with mostly “excellent” and “good”. Satisfaction with the training program was also rated mostly with “excellent” and “good”. Conclusion: The BLS training program effectively improved participants’ knowledge and skills for basic life support. This program should be disseminated to train lay people in other settings. Keywords: Basic life support, Cardiac arrest, Mobile application

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Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest

AACN Advanced Critical Care ◽

10.4037/aacnacc2020297 ◽

2020 ◽

Vol 31 (4) ◽

pp. 401-409

Author(s):

Roberta Kaplow ◽

Pam Cosper ◽

Ray Snider ◽

Martha Boudreau ◽

John D. Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Patient Outcomes ◽

Life Support ◽

Patient Survival ◽

Average Rate ◽

Cardiopulmonary Arrest ◽

Academic Medical Center ◽

Convenience Sample ◽

Resuscitation Guidelines ◽

Hospital Cardiac Arrest

Background Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. Objectives To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. Methods An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. Results Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. Conclusions These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.

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2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽

10.1161/cir.0000000000000736 ◽

2019 ◽

Vol 140 (24) ◽

Author(s):

Jonathan P. Duff ◽

Alexis A. Topjian ◽

Marc D. Berg ◽

Melissa Chan ◽

Sarah E. Haskell ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

American Heart Association ◽

Basic Life Support ◽

Life Support ◽

American Heart ◽

Heart Association ◽

Liaison Committee ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation’s continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

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Inter-rater reliability and comfort in the application of a basic life support termination of resuscitation clinical prediction rule for out of hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2006.10.030 ◽

2007 ◽

Vol 74 (1) ◽

pp. 150-157 ◽

Cited By ~ 10

Author(s):

Laurie J. Morrison ◽

Laura M. Visentin ◽

Marian Vermeulen ◽

Alex Kiss ◽

Robert Theriault ◽

...

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Rater Reliability ◽

Hospital Cardiac Arrest

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Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2018-207833 ◽

2019 ◽

Vol 36 (8) ◽

pp. 479-484 ◽

Cited By ~ 5

Author(s):

Mark H Ebell ◽

Akke Vellinga ◽

Siobhan Masterson ◽

Phillip Yun

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Meta Analysis ◽

Advanced Life Support ◽

Study Quality ◽

European Resuscitation Council ◽

Comprehensive Search ◽

Hospital Cardiac Arrest ◽

Low Rate

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

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The PulsePoint Respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: Challenges for optimal implementation

Resuscitation ◽

10.1016/j.resuscitation.2015.09.392 ◽

2016 ◽

Vol 98 ◽

pp. 20-26 ◽

Cited By ~ 68

Author(s):

Steven C. Brooks ◽

Graydon Simmons ◽

Heather Worthington ◽

Bentley J. Bobrow ◽

Laurie J. Morrison

Keyword(s):

Cardiac Arrest ◽

Mobile Device ◽

Basic Life Support ◽

Life Support ◽

Device Application ◽

Hospital Cardiac Arrest ◽

Optimal Implementation

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Out-of-hospital cardiac arrest

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0009 ◽

2021 ◽

pp. 76-87

Author(s):

Jerry P Nolan ◽

Christian Hassager

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Spontaneous Circulation ◽

Neurological Injury ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Medical Emergencies ◽

Hospital Cardiac Arrest

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

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Abstract 19542: A North American Survey of Public Opinion on the Acceptability of Crowdsourcing Basic Life Support for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.132.suppl_3.19542 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Katie N Dainty ◽

Steven Brooks

Keyword(s):

Cardiac Arrest ◽

North American ◽

Basic Life Support ◽

Life Support ◽

Public Access ◽

The North ◽

The Usa ◽

Bystander Cpr ◽

Use Of Social Media ◽

Hospital Cardiac Arrest

Introduction: Performance of bystander CPR and early defibrillation following out-of-hospital cardiac arrest (OHCA) have been shown to increase the odds of survival to hospital discharge more than 3-fold. The PulsePoint Respond™ Application (App) is a novel system that can be implemented by EMS to crowdsource basic life support for victims of OHCA. The system sends cardiac arrest notifications to a user’s mobile device which includes the location of the emergency and nearby public access defibrillators to facilitate bystander CPR and AED use while EMS personnel are en route. We conducted a North American survey to evaluate public perceptions of such an application, including acceptability and willingness to respond to alerts. Methods: The web-based survey was conducted in Canada and the USA by an established external polling vendor, Ipsos Reid. Sampling was designed to ensure broad representation of gender, age, geography, and spoken language following recent census statistics. Respondents were presented with a short concept description of cardiac arrest and the Pulsepoint app in text format followed by 6 closed-ended and 4 open-ended questions. Results: A random sample of 2,415 total surveys were collected (1106 from Canada and 1309 from the US). 70% of Canadian respondents but only 47% of US respondents had been trained in CPR at some point. On average, 79.5% of respondents agreed that Pulsepoint is something they would like to see in their community and 59.5% said they would download the App. 80% of Canadians and 77% of Americans were comfortable with receiving help in a public setting (street, office, etc) and 72 and 68% respectively, indicated they would be comfortable with receiving help in a private setting (home). Less than 40% of respondents identified concerns; as expected those identified included training concerns and trust issues. An average of 89% of the sample from both countries felt it was important that responders have up-to-date CPR certification. Conclusions: Overall, the North American public find the concept of the Pulsepoint application and crowdsourcing basic life support for OHCA acceptable and would be willing to respond. This is encouraging insight to support the use of social media to increasing bystander CPR rates in North America.

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