Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams

2020 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Simulation Study ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Control Group ◽  
Performance Quality ◽  
Prefilled Syringes ◽  
The Impact

Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.

scholarly journals Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

2021 ◽  
Vol 17 (8) ◽  
pp. 6-19
Author(s):  
L.V. Usenko ◽  
А.V. Tsarev ◽  
Yu.Yu. Kobelatsky
Keyword(s):  
Cardiac Arrest ◽  
Healthcare Workers ◽  
Basic Life Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Advanced Life Support ◽  
European Resuscitation Council ◽  
Improved Outcomes ◽  
Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

Automatic compression improves adherence to advanced life support protocol in two-paramedic team. A randomized simulation study

2020 ◽  
Keyword(s):  
Human Error ◽  
Life Support ◽  
Advanced Life Support ◽  
Supraglottic Airway ◽  
Control Group ◽  
Delivery Time ◽  
Chest Compressions ◽  
Adherence To Guidelines ◽  
Experimental Group

Introduction: The use of protocols reduces the risk of human error and increases healthcare professionals’ adherence to guidelines. In a team of only two providers, following Advanced Life Support (ALS) protocol might be challenging. Automated Chest Compressions Devices (ACCD) may increase the quality of chest compressions. The aim of this study was to evaluate if the use of ACCD in resuscitation by a two-paramedic crew improves adherence to the ALS protocol. Materials and Methods: This study was designed as a prospective randomized high-fidelity cross-over simulation trial. Fifty-two doubleperson teams were enrolled. Each team performed two full resuscitation scenarios: one with ACCD (the experimental group-ACC) and one with manual compressions (the control group-MAN). Results: ACC achieved shorter mean durations of resuscitation loops, being less prolonged in relation to recommended durations than MAN (13 vs. 23 sec over recommended respectively, P = 0.0003). ACC also achieved mean times for supraglottic airway completion significantly faster than MAN: 224 ± 66 s vs 122 ± 35 s (P < 0.0001). In ACC, the intravenous line was obtained earlier then in MAN (162 ± 35 s vs 183 ± 45 s, P = 0.0111). Moreover, the first and second doses of adrenaline (epinephrine) were administered earlier 272± 58 s vs 232 ± 57 s (P = 0.0014) for the first and 486 ± 96 s vs 424 ± 69 s (P = 0.0007) for the second doses, respectively. Mean chest compression fraction (CCF) in MAN group was significantly lower (74 ± 4%) than in ACC group (83 ± 2%) (P < 0.0001). Conclusions: In a simulated setting, ACCD used by two-person paramedic teams yielded earlier achievement of resuscitation endpoints and improved delivery time of compressions. which may have implications for effective clinical resuscitation.

Abstract 146: Evaluation of Out-of-hospital Ventricular Fibrillation Cardiac Arrest Management, With a Simulation Method

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cécile Ursat ◽  
Guillaume Douge ◽  
Charles Groizard ◽  
Anna Ozguler ◽  
Michel Baer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Simulation Method ◽  
Quality Parameters ◽  
Real Patient ◽  
Decision Algorithm ◽  
St Segment Elevation ◽  
Monitoring Devices

Introduction: Feed-back on quality of CPR is an important aspect to consider on cardiac arrest management. This has been pointed out during trainings organized for emergency medicine residents. In parallel, RéAC registry (registry on cardiac arrests in France) showed some difficulties in following guidelines of VF.The aim of this study was to evaluate the performance of Emergency Medical Service (EMS) in the management of patients in cardiac arrest through the use of external chest compression (CC) data from the Resusci Anne Simulator manikin from Laerdal (SimMan®), equipped with SimPad SkillReporter. Methodology: During 2nd to 6th of March 2015, 18 EMS teams (1 physician, 1 paramedic and 1 nurse) were asked to manage a VF on a Resusci Anne Simulator manikin. This allowed the direct measurement of CC quality parameters and the evaluation of decision algorithm, through the use of a same scenario. The scenario was introduced to each team at the beginning of each session. At first, the “patient” was still conscious, on a stretcher and had a ST-segment elevation myocardial infarction. While the patient was installed in the ambulance, he suddenly had a FV cardiac arrest that could be detected on monitoring devices (time 0 of simulation). VF lasted for 10 minutes, followed by 5 minutes of asystole. The manikin software displayed the different parameters as the scenario progressed. The simulation was performed on a stretcher in an EMS premise, with the same equipment and monitoring devices as in an advanced life support ambulance (ALS). Results: CC were performed 71% of CPR time. CC depth was considered as non-compliant to guidelines in 28% of cases, with a mean depth of 4.4 cm, compressions with complete release in 37% of cases. Mean compression rate was 122/minute and was correct in 49% of cases. One third used Amiodarone after the third shock. 13/18 teams resumed chest compressions immediately after defibrillation attempts. Conclusion: This study shows the difficulty to strictly follow guidelines. According to participants, the massage was considered as more difficult with a manikin rather than on a real patient. Although cardiac arrest occurring during transportation is quite rare, quality of CPR at pre-hospital level should be improved.

scholarly journals Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Hye Ji Park ◽  
Won Jung Jeong ◽  
Hyung Jun Moon ◽  
Gi Woon Kim ◽  
Jin Seong Cho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Age Groups ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Fold Increase ◽  
High Quality ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Cpr Quality

Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.

scholarly journals New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

Medicina ◽  
2010 ◽  
Vol 46 (9) ◽  
pp. 571 ◽  
Author(s):  
Andrius Pranskūnas ◽  
Paulius Dobožinskas ◽  
Vidas Pilvinis ◽  
Živilė Petkevičiūtė ◽  
Nedas Jasinskas ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Current Trends ◽  
Resuscitation Guidelines ◽  
Chain Of Survival ◽  
Meta Analyses

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

scholarly journals Sudden cardiac arrest in hypertrophic cardiomyopathy with dynamic cavity obstruction: The case for a decatecholaminisation strategy

2017 ◽  
Vol 19 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Cosmin Balan ◽  
Adrian View-Kim Wong
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Hypertrophy ◽  
Life Support ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
End Diastolic Volume ◽  
Death Spiral ◽  
Hospital Cardiac Arrest

Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a ‘death-spiral’. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching. Within this context, a decatecholaminised strategy comprising a beta-blocker was used to augment the left ventricular end-diastolic volume and attain cardiovascular stability.

scholarly journals Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

2020 ◽  
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Thierry Roupioz ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Traumatic Cardiac Arrest ◽  
Advanced Airway ◽  
Good Neurologic Outcome ◽  
Pelvic Stabilization ◽  
The Impact

Abstract The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

scholarly journals INFLUENCE OF EMERGENCY MEDICAL STUDENTS TRAINING ON PREPAREDNESS TO PERFORM PAEDIATRIC LIFE SUPPORT

2021 ◽  
Vol 8 (4) ◽  
pp. 244-252
Author(s):  
Jerzy Kiszka ◽  
Dawid Filip ◽  
Piotr Wasylik
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Life Support ◽  
Advanced Life Support ◽  
Development Project ◽  
Competence Development ◽  
Emergency Medical ◽  
Before And After ◽  
Post Test ◽  
The Impact

Aim: Assessment of the increase in knowledge in specific categories among students of the last-year emergency medical students after 45-hour training in advanced paediatric life support. Comparison of the impact of participation in the project and the ILS course on the increase of knowledge in the field of advanced life support in children. Material and methods: 138 third-year emergency medical students of the University of Rzeszów were studied. A proprietary questionnaire on paediatric life support was conducted before and after completing a 45-hour training on emergency medical services in children (pretest/posttest). Results: The mean percentage of subjects’ correct answers in the post-test was slightly over 60 which was statistically significantly higher compared to the pre-test, t(276)=6.54; p<0.001. The highest percentage of correct answers concerned paediatric basic life support and AED (M=77.78; SD=12.47), while the lowest – cardiac arrest in children in special situations (M=60.54; SD=21.06). No statistically significant relationship was found between the percentage of correct answers in the pre-test/post-test and the respondents’ age, gender and participation in a competence development project (p>0.05). Conclusions: The knowledge of paediatric life support among the third year emergency medical students is good. The students of subsequent years and individuals reading the literature and participating in the competence development project are better prepared to perform life support procedures in newborns and infants. From year to year, students gain less knowledge from medical literature and have the least knowledge on cardiac arrest in children in special circumstances.

scholarly journals Effects and Retention of Self-Re-Learning Using Video Recording of Advanced Life Support (ALS) On Nursing Students’ Knowledge, Self-Efficacy, and Skills Performance

2020 ◽  
Author(s):  
Kyeongmin Jang ◽  
Sung Hwan Kim ◽  
Ja Young Oh ◽  
Ji Yeon Mun
Keyword(s):  
Cardiac Arrest ◽  
Nursing Students ◽  
Self Efficacy ◽  
Life Support ◽  
Video Recording ◽  
Advanced Life Support ◽  
Control Group ◽  
Control Group Design ◽  
Hospital Deaths ◽  
Experimental Group

Abstract Background In-hospital cardiac arrests account for 80% of hospital deaths, and the survival rate is not significantly different from that of pre-hospitalized cardiac arrest patients. The nurses would presumably be the first to see an in-hospital cardiac arrest patient. This study proposed to measure nursing students’ knowledge, self-efficacy, and skills performance of advanced life support (ALS) 6 months after the training by sending their videos taken during the final skills test after the ALS training.Methods This is an experimental study with a randomized control group design. The participants’ knowledge, self-efficacy, and skill performance of ALS were evaluated immediately after the training and participants were videotaped during the final skills test. Thereafter, we sent the video to the experimental group through the mobile phone messenger application once a month from the third month after training. Approximately six months after the training day, we conducted a follow-up test of the measured variables using the blinded method.Results Six months after the ALS training, knowledge scores decreased significantly in both groups (p<0.001). Self-efficacy decreased by about 3 from 50.55 to 47.18 in the experimental group (p = 0.089), while it decreased by 10 in the control group from 50.67 to 39 (p<0.001). The skills performance decreased from 27.5 to 26.68 in the experimental group, while it decreased significantly from 27.95 to 16.9 in the control group (p< 0.001).Conclusion Self-study with videos taken during an ALS skills test helps enhance the sustainable effects of training, such as knowledge, self-efficacy, and skills performance.

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