Transmission of Infections during Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency life-saving endeavor, performed either in the hospital or outpatient settings, that significantly improves outcome and survival rates when performed timely. As with any other medical procedure, CPR can bare potential risks not only for the patient but also for the rescuers.

Download Full-text

The Iterative Development and Testing of an Interactive Mobile Application for Skill Retention of Cardiopulmonary Resuscitation Among High School Students: A Pilot Study

Simulation & Gaming ◽

10.1177/10468781211032692 ◽

2021 ◽

pp. 104687812110326

Author(s):

Adeel Arif ◽

Amber Arif ◽

Kimberly Anne Fasciglione ◽

Farrukh Nadeem Jafri

Keyword(s):

High School ◽

High School Students ◽

Cardiopulmonary Resuscitation ◽

Mobile Apps ◽

Low Cost ◽

Survival Rates ◽

Compression Rate ◽

School Students ◽

Skill Retention ◽

Before And After

Abstract: Background Locations concentrated with High School (HS) students tend to have lower out-of-hospital cardiac arrest (OHCA) survival rates. Mobile applications (apps) have the capability to augment cardiopulmonary resuscitation (CPR) skill retention as a low-cost, accessible training method. Methods An iterative process to develop an app to reinforce CPR skills emphasizing hand placement, compression rate, real-time feedback, and recurring tips is described. The app was tested on HS students to measure its impact on quality and comfort of CPR using Likert surveys and skills assessments before and after one month of usage. CPR Score and compression rate were measured using the Laerdal™ Little Anne Manikin QCPR software. Results Fourteen HS students participated in a prospective observational study. It was found that the use of the developed app was associated with improved CPR performance (80.43% v. 87.86%, p=0.01-0.02, 95% CI=2.20-12.66) after one month. Additionally, improvements were demonstrated in compression rate accuracy (21.43% v. 64.29%, p=0.041, 95% CI=0.132-0.725), increased comfort performing CPR (3.86 v. 4.79, p<0.001, 95% CI =0.99-1.00) and comfort performing CPR on strangers (2.71 v. 4.42, p<0.001, 95% CI=1.24-2.19). In addition, for every time the app was used, CPR performance increased by 0.5668% (p=0.0182). Conclusion Findings suggest that mobile apps may have promising implications as augmentative tools for CPR curriculums.

Download Full-text

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00481-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Angela Brenton-Rule ◽

Daniel Harvey ◽

Kevin Moran ◽

Daniel O’Brien ◽

Jonathon Webber

Keyword(s):

New Zealand ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Survival Rates ◽

Sudden Cardiac Arrest ◽

Cross Sectional Study ◽

Trial Registration ◽

Cross Sectional ◽

Web Based ◽

The Past

Abstract Background Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. Methods This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. Results 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants’ knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. Conclusions This study provides the first insight into New Zealand podiatrists’ CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study’s findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001144909).

Download Full-text

Balancing benefits and potential risks of vaccination: the precautionary principle and the law of unintended consequences

BMJ evidence-based medicine ◽

10.1136/bmjebm-2021-111773 ◽

2021 ◽

pp. bmjebm-2021-111773

Author(s):

David Robert Grimes

Keyword(s):

Public Health ◽

Precautionary Principle ◽

Unintended Consequences ◽

Vaccine Hesitancy ◽

Public Health Issue ◽

Public Confidence ◽

The Precautionary Principle ◽

Life Saving ◽

Potential Risks ◽

Risk And Benefit

Vaccination is a life-saving endeavour, yet risk and uncertainty are unavoidable in science and medicine. Vaccination remains contentious in the public mind, and vaccine hesitancy is a serious public health issue. This has recently been reignited in the discussion over potential side effects of COVID-19 vaccines, and the decision by several countries to suspend measures such as the AstraZeneca vaccine. In these instances, the precautionary principle has often been invoked as a rationale, yet such heuristics do not adequately weigh potential harms against real benefits. How we analyse, communicate and react to potential harms is absolutely paramount to ensure the best decisions and outcomes for societal health, and maintaining public confidence. While balancing benefits and risks is an essential undertaking, it cannot be achieved without due consideration of several other pertinent factors, especially in the context of vaccination, where misguided or exaggerated fears have in the past imperilled public health. While well meaning, over reactions to potential hazards of vaccination and other health interventions can have unintended consequences, and cause lingering damage to public trust. In this analysis, we explore the challenges of assessing risk and benefit, and the limitations of the precautionary principle in these endeavours. When risk is unclear, cautious vigilance might be a more pragmatic and useful policy than reactionary suspensions.

Download Full-text

Abstract 56: Ventilation Is Necessary During Cardiopulmonary Resuscitation In A Rat Model Of Cardiac Arrest Induced By Airway Obstruction

Circulation ◽

10.1161/circ.116.suppl_16.ii_935 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Akihide Kurita ◽

Takumi Taniguchi ◽

Ken Yamamoto

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Airway Obstruction ◽

Survival Rates ◽

Spontaneous Circulation ◽

Sprague Dawley ◽

Plasma Cytokine ◽

Sprague Dawley Rats ◽

Ventilation Strategies ◽

Lactate Levels

Recent studies have showed that hypoventilation during cardiopulmonary resuscitation (CPR) improved the rates of return of spontaneous circulation (ROSC) and prognosis. However, there are few studies about the ventilation strategies during CPR in cardiac arrest caused by airway obstruction. To compare the effects of the three ventilation strategies during CPR in an animal model of cardiac arrest induced by airway obstruction, we investigated the rates of ROSC, survival rates, plasma cytokine levels, and lactate levels. thirty-six male Sprague Dawley rats were anesthetized with intraperitoneal injection of pentobarbital. Cardiac arrest was induced by airway obstruction. After 3 minutes of cardiac arrest, animals were randomized to receive one of the three ventilation strategies during CPR (n = 12 per group): normoventiraion (28 breaths/min), hypoventilation (14 breaths/min), or no-ventilation. The rates of chest compression (CC) was 240 –260 compressions/min and the depth of CC adjusted to maintain mean arterial pressure more than 25 mmHg in all groups. After 5 minutes of CPR, epinephrine (0.02 mg/kg) was administered, and all rats were ventilated at the rates of 28 breaths/min in FiO2 1.0. The rates of ROSC were 83%, 58%, 0% for the normoventilation, hypoventilation, and no-ventilation groups, respectively. The PaCO2 levels immediately after ROSC were 74mmHg and 88 mmHg for the normoventilation, and hypoventilation groups, respectively. The increases of plasma cytokine (TNF-a, and IL-6) levels and lactate levels after ROSC in the normoventilation group were significantly less than those in the hypoventilation group. The present study showed that normoventilation during CPR improved the rates of ROSC and the survival rates after ROSC in the animal cardiac arrest model induced by airway obstruction. Moreover, normoventilation attenuated the elevation of cytokine and lactate responses. These findings suggest that ventilation may be necessary during CPR in cardiac arrest caused by airway obstruction.

Download Full-text

Recent advances in liver transplantation

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101425 ◽

2021 ◽

pp. flgastro-2020-101425

Author(s):

N Thomas Burke ◽

James B Maurice ◽

David Nasralla ◽

Jonathan Potts ◽

Rachel Westbrook

Keyword(s):

Liver Transplantation ◽

Survival Rates ◽

Machine Perfusion ◽

Allocation System ◽

Life Saving ◽

Opt Out ◽

Normothermic Machine Perfusion ◽

Marginal Grafts ◽

Legislative Changes ◽

The Uk

Liver transplant is a life-saving treatment with 1-year and 5-year survival rates of 90% and 70%, respectively. However, organ demand continues to exceed supply, such that many patients will die waiting for an available organ. This article reviews for the general gastroenterologist the latest developments in the field to reduce waiting list mortality and maximise utilisation of available organs. The main areas covered include legislative changes in organ donation and the new ‘opt-out’ systems being rolled out in the UK, normothermic machine perfusion to optimise marginal grafts, a new national allocation system to maximise benefit from each organ and developments in patient ‘prehabilitation’ before listing. Current areas of research interest, such as immunosuppression withdrawal, are also summarised.

Download Full-text

Perfusion parameters and target values during extracorporeal cardiopulmonary resuscitation: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-030562 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030562

Author(s):

Lars Saemann ◽

Christine Schmucker ◽

Lisa Rösner ◽

Friedhelm Beyersdorf ◽

Christoph Benk

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Scoping Review ◽

Citation Index ◽

Data Extraction ◽

Survival Rates ◽

Social Science Citation Index ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Target Values ◽

Hospital Cardiac Arrest

IntroductionExtracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients. Treatment results are promising, but the efficacy and safety of the procedure are still unclear. Currently, there are no recommended target perfusion parameters during eCPR, the lack of which could result in inadequate (re)perfusion. We aim to perform a scoping review to explore the current literature addressing target perfusion parameters, target values, corresponding survival rates and neurologic outcomes in OHCA and IHCA patients treated with eCPR.Methods and analysisTo identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library. We will also check references of relevant articles and perform a cited reference research (forward citation tracking).Two independent reviewers will screen titles and abstracts, check full texts for eligibility and perform data extraction. We will resolve dissent by consensus, moderated by a third reviewer. We will include observational and controlled studies addressing target perfusion parameters and outcomes such as survival rates and neurologic findings in OHCA and IHCA patients treated with eCPR. Data extraction tables will be set up, including study and patients’ characteristics, aim of study, details on eCPR including target perfusion parameters and reported outcomes. We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe potential clusters and/or gaps.Ethics and disseminationAn ethical approval is not needed. We intend to publish the scoping review in a peer-reviewed journal and present results on a scientific meeting.

Download Full-text

Using an Instructional Package to Teach Cardiopulmonary Resuscitation With Automated External Defibrillator to College Students With Intellectual Disability

The Journal of Special Education ◽

10.1177/0022466918813362 ◽

2018 ◽

Vol 53 (3) ◽

pp. 142-152

Author(s):

Kelly B. Kearney ◽

Charles Dukes ◽

Michael P. Brady ◽

Kalynn Hall Pistorio ◽

Mary Louise Duffy ◽

...

Keyword(s):

College Students ◽

Intellectual Disability ◽

Cardiopulmonary Resuscitation ◽

Phase 1 ◽

Future Research ◽

Automated External Defibrillator ◽

Safety Skills ◽

Life Saving ◽

Instructional Package ◽

External Defibrillator

Adults with intellectual disability may not learn safety skills needed to maintain the safety of those within their communities. Basic life-saving skills are valued by community members and increase independent and integrated living and employment opportunities. This study used an instructional package consisting of modeling, task analysis, and simultaneous prompting to teach college students with intellectual disability a basic life-saving skill, specifically how to perform cardiopulmonary resuscitation (CPR) with the use of an automated external defibrillator (AED). Phase 1 of the study used the instructional package to teach the students to perform CPR. Once mastered, Phase 2 of the study taught students to use an AED, incorporating it into the CPR chain. Results showed that the students’ accuracy with the tasks increased after the introduction of the instructional package, generalized to a novel environment, and maintained once the instructional package was removed. Implications and future research are discussed.

Download Full-text

The Success Rate of Pediatric In-Hospital Cardiopulmonary Resuscitation in Ahvaz Training Hospitals

Scientifica ◽

10.1155/2016/9648140 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Shideh Assar ◽

Mohsen Husseinzadeh ◽

Abdul Hussein Nikravesh ◽

Hannaneh Davoodzadeh

Keyword(s):

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Survival Rates ◽

Cerebral Performance Category ◽

Developed Countries ◽

Spontaneous Circulation ◽

Secondary Outcome ◽

Drug Infusion ◽

Factors Influencing ◽

Favorable Neurological Outcome

Research Objective. This study determined the outcome of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest and factors influencing it in two training hospitals in Ahvaz.Method. Patients hospitalized in the pediatric wards and exposed to CPR during hospital stay were included in the study (September 2013 to May 2014). The primary outcome of CPR was assumed to be the return of spontaneous circulation (ROSC) and the secondary outcome was assumed to be survival to discharge. The neurological outcome of survivors was assessed using the Pediatric Cerebral Performance Category (PCPC) method.Results. Of the 279 study participants, 138 patients (49.4%) showed ROSC, 81 patients (29%) survived for 24 hours after the CPR, and 33 patients (11.8%) survived to discharge. Of the surviving patients, 16 (48.5%) had favorable neurological outcome. The resuscitation during holidays resulted in fewer ROSC. Multivariate analysis showed that longer CPR duration, CPR by junior residents, growth deficiency, and prearrest vasoactive drug infusion were associated with decreased survival to discharge (p<0.05). Infants and patients with respiratory disease had higher survival rates.Conclusion. The rate of successful CPR in our study was lower than rates reported by developed countries. However, factors influencing the outcome of CPR were similar. These results reflect the necessity of paying more attention to pediatric CPR training, postresuscitation conditions, and expansion of intensive care facilities.

Download Full-text

Paediatric liver transplantation

10.1093/med/9780198759928.003.0071 ◽

2018 ◽

Author(s):

Van Jain ◽

Stephen Mouat

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Survival Rates ◽

Assessment Process ◽

Life Saving ◽

Paediatric Liver Transplantation

The chapter on paediatric liver transplantation presents the indications and contraindications of this potentially life-saving procedure. It explains the pre-transplant assessment process and the survival rates that can be expected. It also covers the types of different transplants as well as the initial post-liver transplant management and commonly associated complications.

Download Full-text

Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

Journal of the American Heart Association ◽

10.1161/jaha.119.015368 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Andrew Fu Wah Ho ◽

Nurun Nisa Amatullah De Souza ◽

Audrey L. Blewer ◽

Win Wah ◽

Nur Shahidah ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Emergency Care ◽

Survival Rates ◽

Prehospital Emergency Care ◽

Shockable Rhythm ◽

Automated External Defibrillation ◽

Bystander Cardiopulmonary Resuscitation ◽

Prehospital Emergency ◽

Hospital Cardiac Arrest

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

Download Full-text