Resuscitation plus最新文献

The International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH) Initiative is helping to save countless lives by promoting a culture of preparedness and encouraging widespread lay cardiopulmonary resuscitation (CPR) training. In total from 2018 to 2023 at least 12.6 million people were trained, and 570.7 million people were reached, showing a variety of campaigns adapted to countries current situation and their culture. World Restart a Heart success is based on an annual collaboration between nations, organisations and communities, demonstrating its universal relevance and impact. Because of this it is able to adapt to varies different circumstances and presents an accessible and effective solution to a significant global health problem, saving many lives over the years by promoting bystander CPR.

Background: The Pediatric Life Support Consensus on Science With Treatment Recommendations states that chest compressions (CC) be performed with the 2-thumb-encircling and if the chest can not be encircled the 2-finger-technique.

Aim: To compare the hemodynamic effects of four different compression methods during CC in a piglet model of infant asphyxia.

Methods: Nine asphyxiated infant piglets were randomized to CC with 2-thumb-encircling, 2-thumb-, 2-finger-, and one-hand-techniques for one minute at each technique. CC were performed manually while hemodynamic parameters were continuously measured.

Results: Nine infantile piglets (age 5-10 days, weight 2.1-3.0 kg) were included in the study. The 2-thumb-technique and 2-thumb-encircling technique both had a significantly higher mean (SD) ejection fraction of 52.6 (31.2)% and 64.4 (30.6)% compared to the one-hand-technique with 26.6 (15.1)% (p = 0.005). The 2-thumb-encircling technique also had a significantly higher ejection fraction compared to the 2-finger-technique with values of 64.4 (30.6)% and 30.4 (12.1)%, respectively (p = 0.005). Furthermore, 2-thumb-technique and 2-thumb-encircling technique produced significantly higher carotid blood flow and dp/dt_max, and significantly lower dp/dt_min compared to the one-hand- and 2-finger-techniques.

Conclusion: The 2-thumb- and 2-thumb-encircling-techniques produced significantly higher ejection fraction, carotid blood flow, and dp/dt_max, and lower dp/dt_min compared to the 2-finger- and one-hand-techniques. Encircling the chest during the 2-thumb-technique produces similar hemodynamic effects compared to the 2-thumb-technique without encircling.

A 36-year-old woman at 23 weeks and 3 days of gestation experienced a witnessed cardiopulmonary collapse. Bystander cardiopulmonary resuscitation (CPR) was initiated immediately. After advanced life support, she was transferred under mechanical CPR to a hospital for extracorporeal membrane oxygenation (ECMO). There, a delayed perimortem caesarean section (PMCS) was performed. Consideration to initiate ECMO following the PMCS was ultimately discontinued due to extensive intra-abdominal haemorrhage and the elapsed time of over one hour since the collapse. A full body computed tomography (CT) scan following ROSC revealed bilateral pulmonary embolisms and grade 4 liver laceration with active bleeding due to mechanical CPR. Despite the prolonged duration of cardiac arrest (69 min) and significant metabolic derangements, the patient had a favourable recovery and was discharged after 42 days with a good neurological outcome. This case illustrates the challenges of timely perimortem caesarean section in out-of-hospital cardiac arrest, where guidelines recommend performing the procedure within 4 min of maternal collapse. It also highlights the risks associated with mechanical chest compression devices.

Background: The Irish Out-of-Hospital Cardiac Arrest registry (OHCAR) collects data based on the internationally recognised Utstein template. The Utstein comparator group (bystander witnessed and initial shockable rhythm) has specific relevance in benchmarking out-of-hospital cardiac arrest (OHCA) health system performance.

Aims: To describe OHCA in the Utstein comparator group during 2012 to 2020 in Ireland. To explore predictors of bystander CPR, defibrillation, and survival to hospital discharge.

Methods: National level OHCA registry data were interrogated. The subset of patients in the Utstein comparator group were identified and explored. Multivariable logistic regression was used to model outcome predictors.

Results: There were 3,092 cases of OHCA in the Utstein comparator group during 2012 to 2020. Overall survival to hospital discharge was 27%. On average there were yearly improvements in bystander CPR, bystander defibrillation, and survival. Bystander CPR was associated with a 57% increase, while bystander defibrillation was associated with a 78% increase in the adjusted odds of survival to hospital discharge. The adjusted odds of both bystander CPR and defibrillation were higher in rural areas, despite decreased survival in these communities when compared to urban. OHCA that occurred at home was associated with decreased odds of bystander CPR, bystander defibrillation, and survival to hospital discharge.

Conclusions: Bystander CPR, bystander defibrillation and survival to hospital discharge have increased in the Utstein comparator group during 2012-2020 in Ireland. Bystander CPR and defibrillation remain key modifiable health systems targets to increase overall OHCA survival.

Aim and background: There are various theories regarding the ideal hand to be in contact with chest during chest compressions when healthcare professionals and medical students perform cardiopulmonary resuscitation (CPR). Our study aimed to compare the impact of preferred versus non-preferred hand placement on chest on the CPR quality.

Methodology: The volunteers were randomised to place their preferred (P)/non-preferred (NP) hand over sternum for the first session and switch hands for the second. Participants performed 2 min of uninterrupted chest compressions, followed by a 2-minute break and another 2 min of chest compressions on Laerdel QCPR Little Anne® mannequin with auditory feedback. The CPR parameters were analysed using QCPR mobile application. Comfort was assessed using 5-point Likert scale.

Results: Among the 82 volunteers, 51 participants (62.2%) preferred their dominant hand to be in contact with the chest. Comparable results were seen with mean QCPR score, rate of compression, mean depth and good recoil percentage. The NP set had higher adequate depth percentage (94.8 +/- 13.7) than the P set (92.3 +/- 19.9) (p = 0.042), but participants were more comfortable using their preferred hand over chest (p = 0.0001).

Conclusion: Rescuer performance during chest compressions may not be impacted by whether the preferred hand or non-preferred hand of the provider is in contact with sternum.

Background: Self-directed training has been recognized as a reasonable alternative to traditional instructor-led formats to teach laypeople Basic Life Support (BLS). Virtual tools can facilitate high-quality self-directed resuscitation education; however, their role in teaching paediatric BLS remains unclear due to limited empiric evaluation and suboptimal design of existing tools.

Aim: We describe the development and evaluation of a virtual simulation game (VSG) designed to teach high-quality paediatric BLS using a self-directed, online format with integrated deliberate practice and feedback.

Methods: We conducted a pilot prospective single-arm cohort study examining the VSG's impact on laypeople's paediatric BLS self-efficacy, attitudes, and knowledge as well as learner reactions. Data was collected using online surveys immediately after VSG completion and was analysed using descriptive statistics.

Results: Fifty-five participants (median age 32 years, 76% female, 11% active certification in paediatric BLS) evaluated the VSG. Participants reported high self-efficacy, willingness to perform paediatric BLS, and high perceived knowledge after VSG completion. Fifty (91%) achieved a passing score (≥13/15) on the paediatric BLS knowledge assessment. Learner reactions were favourable with 98% of participants agreeing that VSG educational content was clear and helpful. Mean System Usability Scale score was 81.1 (standard deviation 12.6) with a Net Promoter Score of 32 indicating high levels of usability and likelihood to recommend to others.

Conclusions: The VSG was well-received by laypeople with positive effects observed on paediatric BLS self-efficacy, attitudes, and knowledge. Future studies should examine the impact of VSGs on skill performance through standalone or blended learning approaches.

Trauma care prioritizes life-threatening conditions using the ABCDE algorithm based on the principle "treat first what kills first". As for catastrophic hemorrhage, a leading preventable cause of death in trauma, modifications of this algorithm are necessary in specific cases. In cold climates, life-threatening hypothermia poses additional challenges. Rapid cooling of a patient's core temperature, especially when immobile or poorly insulated, necessitates early prevention. Modified algorithms like the military MhARCH therefore prioritize hypothermia management alongside hemorrhage control in extreme conditions. This article advocates for the crABCDE approach in civilian rescue, emphasizing immediate hypothermia prevention in cold, wet, or high-altitude environments. Tailored protocols that consider environmental risks and patient factors are essential for improving outcomes in both military and civilian trauma care.

Background: Although the association of peripheral skin temperature with infection, serious illness and death have been recognised for centuries, few studies have explicitly compared this finding with other bedside indicators of illness severity. This study compared subjectively assessed dorsal forearm skin temperature and moisture with other indicators of illness severity.

Methods: Non-interventional observational study of acutely ill medical patients admitted to a low-resource Ugandan hospital, which examined the association of subjectively assessed dorsal forearm skin temperature and other bedside findings with death within 24 h.

Results: While in hospital 653 patients had 2,104 observations; the dorsal forearm skin was subjectively felt to be abnormally hot or cold at 239 observations, and this finding was associated with 24-hour mortality (odds ratio 4.48, 95% CI 1.89-10.46); this increased risk of death was comparable to the increased mortality risk associated with tachypnoea, hypoxia, and a Shock Index >1.0, but considerably lower than that associated with a Kitovu Fast Triage score >0. When stratified according to both temperature and wetness, 'cold and wet' and 'hot and wet' skin were associated with higher early warning scores. Cold or hot forearm skin had a specificity for 24-hour mortality of 0.83, but a sensitivity of only 0.34; therefore, its absence does not rule-out the chance of imminent death.

Conclusion: Touching and feeling the skin temperature and moisture is a valuable clinical sign, which can be rapidly determined at the bedside. However, although it has high specificity, its sensitivity for imminent death is low.