Pub Date : 2024-10-24DOI: 10.1016/j.resplu.2024.100802
Priscilla Yu , Javier J Lasa , Xuemei Zhang , Heather Griffis , Todd Sweberg , Ivie Esangbedo , Abhay Ranganathan , Vinay Nadkarni , Tia Raymond , for the pedi-RESQ Investigators
Objective
To evaluate the association of CPR quality metrics with survival outcomes in children with and without congenital heart disease experiencing in-hospital cardiac arrest.
Design
Retrospective cohort study of data from the Pediatric Resuscitation Quality (pediRES-Q) Collaborative.
Setting
28 participating sites.
Patients
Patients who were < 18 years of age at time of arrest, ≥ 37 weeks gestational age, with ≥ 1 min of monitor-defibrillator chest compression quality metric data recorded.
Interventions
None.
Measurements and Main Results
There were a total of 742 index in-hospital cardiac arrest events in 675 unique patients analyzed between July 2015 and August 2021. Amongst these events, 205 (27.6%) occurred in patients with congenital heart disease and 537 (72.4%) in patients without congenital heart disease. After adjusting for age and use of extracorporeal CPR during arrest, children with congenital heart disease were less likely to have chest compression depth that met compliance with American Heart Association guidelines than children without congenital heart disease. Despite differences in CC depth, the presence of congenital heart disease was not associated with return of spontaneous circulation, survival to hospital discharge, or SHD with favorable neurologic outcome on multivariable logistic mixed effects modeling.
Conclusions
In a large multi-center international pediatric resuscitation collaborative, patients with congenital heart disease compared to those without were less likely to have guideline-compliant CC depth yet no differences in return of spontaneous circulation, survival to hospital discharge or survival to discharge with favorable neurologic outcome were observed on multivariable analysis.
{"title":"Are chest compression quality metrics different in children with and without congenital heart disease? A report from the pediatric resuscitation quality collaborative","authors":"Priscilla Yu , Javier J Lasa , Xuemei Zhang , Heather Griffis , Todd Sweberg , Ivie Esangbedo , Abhay Ranganathan , Vinay Nadkarni , Tia Raymond , for the pedi-RESQ Investigators","doi":"10.1016/j.resplu.2024.100802","DOIUrl":"10.1016/j.resplu.2024.100802","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association of CPR quality metrics with survival outcomes in children with and without congenital heart disease experiencing in-hospital cardiac arrest.</div></div><div><h3>Design</h3><div>Retrospective cohort study of data from the Pediatric Resuscitation Quality (pediRES-Q) Collaborative.</div></div><div><h3>Setting</h3><div>28 participating sites.</div></div><div><h3>Patients</h3><div>Patients who were < 18 years of age at time of arrest, ≥ 37 weeks gestational age, with ≥ 1 min of monitor-defibrillator chest compression quality metric data recorded.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>There were a total of 742 index in-hospital cardiac arrest events in 675 unique patients analyzed between July 2015 and August 2021. Amongst these events, 205 (27.6%) occurred in patients with congenital heart disease and 537 (72.4%) in patients without congenital heart disease. After adjusting for age and use of extracorporeal CPR during arrest, children with congenital heart disease were less likely to have chest compression depth that met compliance with American Heart Association guidelines than children without congenital heart disease. Despite differences in CC depth, the presence of congenital heart disease was not associated with return of spontaneous circulation, survival to hospital discharge, or SHD with favorable neurologic outcome on multivariable logistic mixed effects modeling.</div></div><div><h3>Conclusions</h3><div>In a large multi-center international pediatric resuscitation collaborative, patients with congenital heart disease compared to those without were less likely to have guideline-compliant CC depth yet no differences in return of spontaneous circulation, survival to hospital discharge or survival to discharge with favorable neurologic outcome were observed on multivariable analysis.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100802"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.resplu.2024.100805
Ashlea Smith , Judith Finn , Karen Stewart , Stephen Ball
Background
Rurality has been shown to have a strong effect on survival from out-of-hospital cardiac arrest (OHCA), with survival in rural areas approximately half that of metropolitan areas. Western Australia provides a unique landscape to understand the impact of rurality, with 2.6 million people spread across 2.5 million km2. We conducted a scale geospatial analysis with respect to population density and proximity to services, to understand the impact of rurality on bystander interventions, prehospital management and survival of OHCA patients.
Methods
We conducted a retrospective cohort study with a geospatial analysis of ambulance-attended, medical OHCA cases from 2015 to 2022. We compared bystander interventions, distances to services, population density and survival outcomes, stratified by a four-scale regional (broad scale) categorisation of rurality, and proximity to town scale.
Results
There were a total of 6,763 cases within the study cohort (Major Cities- 5,186, Inner Regional- 605, Outer Regional-599 and Remote- 373). The majority of OHCAs occurred within towns, and within close proximity to people and health services. Bystander interventions were higher for more remote cases. Increased distance from town was associated with a 5 % decrease per kilometre in the odds of Return of Spontaneous Circulation (ROSC) on arrival at hospital (OR = 0.95 [95 % Confidence Interval 0.92–0.98]). Despite close proximity to ambulance services, ambulance response times were more prolonged with increasing remoteness.
Conclusions
OHCA cases within regions classified as Regional and Remote typically occurred within towns, and in close proximity to emergency services. However, ambulance response times within rural and remote towns were long relative to their proximity to ambulance stations. These findings provide a new perspective on the issue of remoteness for OHCA cases.
{"title":"Dispelling the remoteness myth- a geospatial analysis of where out-of-hospital cardiac arrests are occurring in Western Australia","authors":"Ashlea Smith , Judith Finn , Karen Stewart , Stephen Ball","doi":"10.1016/j.resplu.2024.100805","DOIUrl":"10.1016/j.resplu.2024.100805","url":null,"abstract":"<div><h3>Background</h3><div>Rurality has been shown to have a strong effect on survival from out-of-hospital cardiac arrest (OHCA), with survival in rural areas approximately half that of metropolitan areas. Western Australia provides a unique landscape to understand the impact of rurality, with 2.6 million people spread across 2.5 million km<sup>2</sup>. We conducted a scale geospatial analysis with respect to population density and proximity to services, to understand the impact of rurality on bystander interventions, prehospital management and survival of OHCA patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study with a geospatial analysis of ambulance-attended, medical OHCA cases from 2015 to 2022. We compared bystander interventions, distances to services, population density and survival outcomes, stratified by a four-scale regional (broad scale) categorisation of rurality, and proximity to town scale.</div></div><div><h3>Results</h3><div>There were a total of 6,763 cases within the study cohort (Major Cities- 5,186, Inner Regional- 605, Outer Regional-599 and Remote- 373). The majority of OHCAs occurred within towns, and within close proximity to people and health services. Bystander interventions were higher for more remote cases. Increased distance from town was associated with a 5 % decrease per kilometre in the odds of Return of Spontaneous Circulation (ROSC) on arrival at hospital (OR = 0.95 [95 % Confidence Interval 0.92–0.98]). Despite close proximity to ambulance services, ambulance response times were more prolonged with increasing remoteness.</div></div><div><h3>Conclusions</h3><div>OHCA cases within regions classified as Regional and Remote typically occurred within towns, and in close proximity to emergency services. However, ambulance response times within rural and remote towns were long relative to their proximity to ambulance stations. These findings provide a new perspective on the issue of remoteness for OHCA cases.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100805"},"PeriodicalIF":2.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.resplu.2024.100800
Tharusan Thevathasan , Sonia Lech , Andreas Diefenbach , Elisa Bechthold , Tim Gaßmann , Sebastian Fester , Georg Girke , Wulf Knie , Benjamin T. Lukusa , Sebastian Kühn , Steffen Desch , Ulf Landmesser , Carsten Skurk
Aim
Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group).
Methods
In a prospective manner, ECMO circuits were either pre-assembled and pre-primed under sterile conditions, maintained for 21 days with culture samples taken every seventh day, or newly assembled and primed during the acute emergency situation. The transition from on-demand assembly and priming of ECMO circuits to pre-primed ECMO circuits occurred on January 1st, 2021. The interval between patients’ arrival in the cardiac catheterization laboratory and the initiation of ECMO was recorded and retrospectively compared between the two treatment groups. The ECPR team, comprising experienced cardiologists and nurses, was prospectively surveyed using the modified Perceived Stress Questionnaire (PSQ-20).
Results
All aseptically pre-assembled and pre-primed ECMO circuits demonstrated sterile cultures for aerobic and anaerobic microorganisms as well as fungal agents over the 21-day period: 0/120 positive cultures (0 %, 95 % CI for binomial probability 0–0.03). The time to ECMO initiation was significantly reduced in the pre-primed group compared to the on-demand group: 13 [IQR 9–17] versus 31 [IQR 27–44] minutes, P < 0.001. Responses from ECPR physicians and nurses on the PSQ-20 were similar across all items. With the use of pre-primed ECMO circuits, all ECPR professionals reported a greater sense of settled inner feeling, considerably less psychological tension, fewer worries and insecurities, as well as more effective ICU shifts with improved personal goal achievement. However, treating ECPR patients with pre-primed ECMO circuits did not lead to increased job satisfaction or higher physical energy levels.
Conclusion
Aseptically pre-assembled and pre-primed ECMO circuits maintain sterility for multiple weeks, significantly reducing ECMO initiation times and alleviating psychological strain on the ECPR team. Consequently, implementing these circuits in ECPR centers could enhance both patient outcomes and healthcare provider well-being.
{"title":"Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care","authors":"Tharusan Thevathasan , Sonia Lech , Andreas Diefenbach , Elisa Bechthold , Tim Gaßmann , Sebastian Fester , Georg Girke , Wulf Knie , Benjamin T. Lukusa , Sebastian Kühn , Steffen Desch , Ulf Landmesser , Carsten Skurk","doi":"10.1016/j.resplu.2024.100800","DOIUrl":"10.1016/j.resplu.2024.100800","url":null,"abstract":"<div><h3>Aim</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group).</div></div><div><h3>Methods</h3><div>In a prospective manner, ECMO circuits were either pre-assembled and pre-primed under sterile conditions, maintained for 21 days with culture samples taken every seventh day, or newly assembled and primed during the acute emergency situation. The transition from on-demand assembly and priming of ECMO circuits to pre-primed ECMO circuits occurred on January 1st, 2021. The interval between patients’ arrival in the cardiac catheterization laboratory and the initiation of ECMO was recorded and retrospectively compared between the two treatment groups. The ECPR team, comprising experienced cardiologists and nurses, was prospectively surveyed using the modified Perceived Stress Questionnaire (PSQ-20).</div></div><div><h3>Results</h3><div>All aseptically pre-assembled and pre-primed ECMO circuits demonstrated sterile cultures for aerobic and anaerobic microorganisms as well as fungal agents over the 21-day period: 0/120 positive cultures (0 %, 95 % CI for binomial probability 0–0.03). The time to ECMO initiation was significantly reduced in the pre-primed group compared to the on-demand group: 13 [IQR 9–17] versus 31 [IQR 27–44] minutes, P < 0.001. Responses from ECPR physicians and nurses on the PSQ-20 were similar across all items. With the use of pre-primed ECMO circuits, all ECPR professionals reported a greater sense of settled inner feeling, considerably less psychological tension, fewer worries and insecurities, as well as more effective ICU shifts with improved personal goal achievement. However, treating ECPR patients with pre-primed ECMO circuits did not lead to increased job satisfaction or higher physical energy levels.</div></div><div><h3>Conclusion</h3><div>Aseptically pre-assembled and pre-primed ECMO circuits maintain sterility for multiple weeks, significantly reducing ECMO initiation times and alleviating psychological strain on the ECPR team. Consequently, implementing these circuits in ECPR centers could enhance both patient outcomes and healthcare provider well-being.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100800"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the public’s preference to a recognisable and meaningful signage for Automated External Defibrillators (AEDs) in alignment with ISO 7010 standards, aiming to identify improvements for better public awareness and response during out-of-hospital cardiac arrests (OHCA).
Methods
A survey was administered via SurveyMonkey® and Heart of the Nation’s social media. The survey evaluated recognition of ISO signage colors and AED symbols, and preferences for alternative AED signs. Baseline data including geographic location, industry employment, and first aid training were collected.
Results
A total of 935 responses were received (Heart of the Nation’s social media (n = 244) Survey Monkey’s (paid, and independent of Heart of the Nation, n = 691). There were 511 from the US and Canada (54.65 %), 222 from the UK and Europe (23.76 %), 133 from the Asia Pacific (14.22 %), 6 from South America (0.64 %), 2 from the Middle East (0.21 %), and 61 from other territories (6.53 %). Among participants, 455 (48.66 %) were first aid trained. The healthcare sector was the most common employment (n = 155, 16.58 %). Only 187 (20 %) participants correctly identified the ISO AED sign. The preferred sign was a yellow sign with a red heart and blue font, chosen by 252 (27 %) participants.
Conclusion
Current ISO 7010 AED signage is not widely recognised, and is only correctly interpreted by a small percentage of the public. The study suggests a need for more intuitive and visually distinct signage, such as the preferred yellow sign, to improve visibility and understanding, thereby enhancing AED accessibility and usage in OHCA.
{"title":"Iso-lating optimal automated external defibrillator signage: An international survey","authors":"Brandon Stretton , Gregory Page , Joshua Kovoor , Ammar Zaka , Aashray Gupta , Stephen Bacchi , Anjalee Amarasekera , Anoja Gunaratne , Aravinda Thiagalingam , Gopal Sivagangabalan , Pramesh Kovoor","doi":"10.1016/j.resplu.2024.100798","DOIUrl":"10.1016/j.resplu.2024.100798","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigated the public’s preference to a recognisable and meaningful signage for Automated External Defibrillators (AEDs) in alignment with ISO 7010 standards, aiming to identify improvements for better public awareness and response during out-of-hospital cardiac arrests (OHCA).</div></div><div><h3>Methods</h3><div>A survey was administered via SurveyMonkey® and Heart of the Nation’s social media. The survey evaluated recognition of ISO signage colors and AED symbols, and preferences for alternative AED signs. Baseline data including geographic location, industry employment, and first aid training were collected.</div></div><div><h3>Results</h3><div>A total of 935 responses were received (Heart of the Nation’s social media (n = 244) Survey Monkey’s (paid, and independent of Heart of the Nation, n = 691). There were 511 from the US and Canada (54.65 %), 222 from the UK and Europe (23.76 %), 133 from the Asia Pacific (14.22 %), 6 from South America (0.64 %), 2 from the Middle East (0.21 %), and 61 from other territories (6.53 %). Among participants, 455 (48.66 %) were first aid trained. The healthcare sector was the most common employment (n = 155, 16.58 %). Only 187 (20 %) participants correctly identified the ISO AED sign. The preferred sign was a yellow sign with a red heart and blue font, chosen by 252 (27 %) participants.</div></div><div><h3>Conclusion</h3><div>Current ISO 7010 AED signage is not widely recognised, and is only correctly interpreted by a small percentage of the public. The study suggests a need for more intuitive and visually distinct signage, such as the preferred yellow sign, to improve visibility and understanding, thereby enhancing AED accessibility and usage in OHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100798"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142524012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.resplu.2024.100799
John Lombard , Hope Davidson , Owen Doody
Aim
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) codes record the decision to withhold CPR in cases of circulatory arrest. These decisions involve various clinical, ethical and legal complexities promoting increased focus on the decision-making process. This research sought to capture healthcare workers perspective on DNACPR practices and policies in Ireland.
Methods
A cross-sectional descriptive survey utilising a questionnaire developed and piloted for this study to gather responses on open and closed questions. Data were analysed using SPSS and content analysis. Study is reported in line with the Consensus-Based Checklist for Reporting of Survey Studies reporting guidelines.
Results
784 participants including doctors, nurses, paramedics and other healthcare workers completed the questionnaire. 80.5 % (n = 625) of participants rated their knowledge of DNACPR decision-making as fair or better. 77.5 % (n = 601) of participants understood DNACPR to mean ‘no chest compressions, defibrillation or artificial ventilation in the event of cardiopulmonary arrest’. A majority of participants (60.2 % n = 467) had experienced a degree of conflict related to a DNACPR decision. 245 (31.25%) participants provided comments which addressed issues such as communication, education, pressure surrounding DNACPR decisions, the role of national guidelines/documentation, and legal concerns.
Conclusion
The findings reveal gaps in healthcare workers' understanding and familiarity with DNACPR policies, highlighting the need for improved patient involvement and proactive discussions. Effective communication and comprehensive training are crucial, as communication remains a significant barrier. While national policies can provide clarity, increasing awareness and understanding of these policies among healthcare workers is essential.
{"title":"A survey study of healthcare workers on do not Attempt cardiopulmonary resuscitation practice and policy in Ireland","authors":"John Lombard , Hope Davidson , Owen Doody","doi":"10.1016/j.resplu.2024.100799","DOIUrl":"10.1016/j.resplu.2024.100799","url":null,"abstract":"<div><h3>Aim</h3><div>Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) codes record the decision to withhold CPR in cases of circulatory arrest. These decisions involve various clinical, ethical and legal complexities promoting increased focus on the decision-making process. This research sought to capture healthcare workers perspective on DNACPR practices and policies in Ireland.</div></div><div><h3>Methods</h3><div>A cross-sectional descriptive survey utilising a questionnaire developed and piloted for this study to gather responses on open and closed questions. Data were analysed using SPSS and content analysis. Study is reported in line with the Consensus-Based Checklist for Reporting of Survey Studies reporting guidelines.</div></div><div><h3>Results</h3><div>784 participants including doctors, nurses, paramedics and other healthcare workers completed the questionnaire. 80.5 % (n = 625) of participants rated their knowledge of DNACPR decision-making as fair or better. 77.5 % (n = 601) of participants understood DNACPR to mean ‘no chest compressions, defibrillation or artificial ventilation in the event of cardiopulmonary arrest’. A majority of participants (60.2 % n = 467) had experienced a degree of conflict related to a DNACPR decision. 245 (31.25%) participants provided comments which addressed issues such as communication, education, pressure surrounding DNACPR decisions, the role of national guidelines/documentation, and legal concerns.</div></div><div><h3>Conclusion</h3><div>The findings reveal gaps in healthcare workers' understanding and familiarity with DNACPR policies, highlighting the need for improved patient involvement and proactive discussions. Effective communication and comprehensive training are crucial, as communication remains a significant barrier. While national policies can provide clarity, increasing awareness and understanding of these policies among healthcare workers is essential.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100799"},"PeriodicalIF":2.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.resplu.2024.100793
Matthew J. Douma , Samina Ali , Tim A.D. Graham , Allison Bone , Sheila D. Early , Calah Myhre , Kim Ruether , Katherine E. Smith , Kristin Flanary , Thilo Kroll , Kate Frazer , Peter G. Brindley
Introduction
This study aimed to i) identify the care needs of families experiencing cardiac arrest; and ii) co-identify strategies for meeting the identified care needs. Cardiac arrest survivors and family members (of survivors and non-survivors) were engaged as “experience experts,” collaborators and co-researchers in this study.
Methods
A qualitative study using semi-structured interviews of cardiac arrest survivors and family members was conducted. Participants were recruited from the membership of the Family Centred Cardiac Arrest Care Project. Interviews were recorded, transcribed, and analysed using Framework analysis.
Results
Twenty-eight participants described 22 unique cardiac arrest events. We identified five primary care need themes: 1) “Help us help our loved one”; 2) “Work with us as a cohesive team”; 3) “See us: treat us with humanity and dignity”; 4) “Address our family’s ongoing emergency”; and 5) “Help us to heal after the cardiac arrest” as well as 29 subordinate care need themes. We performed touchpoint mapping to identify key moments of interaction between patients and families, and the health system to highlight potential areas for improvement, as well as strategies for meeting family care needs.
Conclusion
Our participants identified varied family care needs during and long after cardiac arrest. Fortunately, many proposed strategies are inexpensive and have low barriers to adoption. However, some unmet care needs identified suggest larger systemic issues such as service gaps that leave families feeling abandoned and isolated. Overall, our findings suggest that care during and after cardiac arrest are critical components of a comprehensive cardiac arrest care system.
{"title":"Navigating cardiac arrest together: A survivor and family-led co-design study of family needs and care touchpoints","authors":"Matthew J. Douma , Samina Ali , Tim A.D. Graham , Allison Bone , Sheila D. Early , Calah Myhre , Kim Ruether , Katherine E. Smith , Kristin Flanary , Thilo Kroll , Kate Frazer , Peter G. Brindley","doi":"10.1016/j.resplu.2024.100793","DOIUrl":"10.1016/j.resplu.2024.100793","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to i) identify the care needs of families experiencing cardiac arrest; and ii) co-identify strategies for meeting the identified care needs. Cardiac arrest survivors and family members (of survivors and non-survivors) were engaged as “experience experts,” collaborators and co-researchers in this study.</div></div><div><h3>Methods</h3><div>A qualitative study using semi-structured interviews of cardiac arrest survivors and family members was conducted. Participants were recruited from the membership of the Family Centred Cardiac Arrest Care Project. Interviews were recorded, transcribed, and analysed using Framework analysis.</div></div><div><h3>Results</h3><div>Twenty-eight participants described 22 unique cardiac arrest events. We identified five primary care need themes: 1) “Help us help our loved one”; 2) “Work with us as a cohesive team”; 3) “See us: treat us with humanity and dignity”; 4) “Address our family’s ongoing emergency”; and 5) “Help us to heal after the cardiac arrest” as well as 29 subordinate care need themes. We performed touchpoint mapping to identify key moments of interaction between patients and families, and the health system to highlight potential areas for improvement, as well as strategies for meeting family care needs.</div></div><div><h3>Conclusion</h3><div>Our participants identified varied family care needs during and long after cardiac arrest. Fortunately, many proposed strategies are inexpensive and have low barriers to adoption. However, some unmet care needs identified suggest larger systemic issues such as service gaps that leave families feeling abandoned and isolated. Overall, our findings suggest that care during and after cardiac arrest are critical components of a comprehensive cardiac arrest care system.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100793"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.resplu.2024.100801
Aurora Magliocca , Donatella De Zani , Giulia Merigo , Marianna Cerrato , Daria De Giorgio , Francesca Motta , Francesca Fumagalli , Davide Zani , Giacomo Grasselli , Giuseppe Ristagno
Introduction
Pneumothorax is a potentially life-treating condition that can represents a complication of cardiopulmonary resuscitation (CPR). An increase in the total amount of air within the thorax may act as an insulator increasing transthoracic impedance (TTI). The aim of this study was to evaluate the effects of pneumothorax on TTI and on resuscitation success in a swine model of cardiac arrest (CA) and CPR.
Methods
Forty pigs undergoing CA and prolonged CPR, and with a chest CT scan performed after resuscitation were included in the study. Pneumothorax was classified as mild, moderate, or severe whether the space occupied by the gas was <15 %, 15–50 %, or >50 % of the hemithorax. TTI was measured and recorded by the defibrillator before each defibrillation, and the last one was used for the analyses. Rate of return of spontaneous circulation (ROSC) and survival up to 96 h were assessed.
Results
Seven (17%) animals had mild-moderate pneumothorax and 10 (25%) severe pneumothorax. Mean TTI was significantly higher in pigs with pneumothorax compared to those without. The rate of ROSC was significantly lower in pigs with pneumothorax compared to those without (53% vs 83%). TTI increased progressively with the size of pneumothorax (mean TTI: 55 O no pneumothorax, vs 62 O mild-moderate vs 66 O severe pneumothorax). Rib fractures were present in all animals with mild-moderate and severe pneumothorax, and in 91% of those without. The total number of rib fractures was significantly higher in animals with severe pneumothorax compared to those without pneumothorax.
Conclusion
Pneumothorax causes TTI increases which are proportional to the size of the pneumothorax and ultimately reduce resuscitation success. High prevalence of chest skeletal injuries was observed in this study regardless of the presence of pneumothorax with higher amount of rib fractures in animals with severe pneumothorax. TTI measured by defibrillator can be used to detect the presence of pneumothorax during CPR. Future studies should explore this concept of TTI as a diagnostic tool, in order to improve resuscitation outcome in patients with pneumothorax.
导言气胸是心肺复苏（CPR）的一种并发症，有可能危及生命。胸腔内空气总量的增加可作为绝缘体增加经胸阻抗（TTI）。本研究旨在评估气胸对 TTI 的影响以及对猪心脏骤停（CA）和心肺复苏模型中复苏成功率的影响。无论气体占据的空间占半胸腔的比例是 15%、15-50% 还是 50%，气胸都被分为轻度、中度和重度。每次除颤前，除颤仪都会测量并记录 TTI，最后一次用于分析。结果7只动物（17%）出现轻中度气胸，10只动物（25%）出现重度气胸。与无气胸的猪相比，有气胸的猪的平均TTI明显较高。与无气胸的猪相比，有气胸的猪的苏醒率明显较低（53% 对 83%）。TTI随气胸的大小而逐渐增加（平均TTI：55 O无气胸 vs 62 O轻中度气胸 vs 66 O重度气胸）。所有轻度-中度和重度气胸动物都有肋骨骨折，91%的无气胸动物也有肋骨骨折。结论气胸会导致TTI增加，而TTI的增加与气胸的大小成正比，最终会降低复苏的成功率。本研究观察到，无论是否存在气胸，胸部骨骼损伤的发生率都很高，严重气胸的动物肋骨骨折的发生率更高。除颤仪测量的 TTI 可用于检测心肺复苏过程中是否存在气胸。未来的研究应探索将 TTI 作为诊断工具的概念，以改善气胸患者的复苏效果。
{"title":"Detecting pneumothorax during cardiopulmonary resuscitation: The potential of defibrillator measured transthoracic impedance","authors":"Aurora Magliocca , Donatella De Zani , Giulia Merigo , Marianna Cerrato , Daria De Giorgio , Francesca Motta , Francesca Fumagalli , Davide Zani , Giacomo Grasselli , Giuseppe Ristagno","doi":"10.1016/j.resplu.2024.100801","DOIUrl":"10.1016/j.resplu.2024.100801","url":null,"abstract":"<div><h3>Introduction</h3><div>Pneumothorax is a potentially life-treating condition that can represents a complication of cardiopulmonary resuscitation (CPR). An increase in the total amount of air within the thorax may act as an insulator increasing transthoracic impedance (TTI). The aim of this study was to evaluate the effects of pneumothorax on TTI and on resuscitation success in a swine model of cardiac arrest (CA) and CPR.</div></div><div><h3>Methods</h3><div>Forty pigs undergoing CA and prolonged CPR, and with a chest CT scan performed after resuscitation were included in the study. Pneumothorax was classified as mild, moderate, or severe whether the space occupied by the gas was <15 %, 15–50 %, or >50 % of the hemithorax. TTI was measured and recorded by the defibrillator before each defibrillation, and the last one was used for the analyses. Rate of return of spontaneous circulation (ROSC) and survival up to 96 h were assessed.</div></div><div><h3>Results</h3><div>Seven (17%) animals had mild-moderate pneumothorax and 10 (25%) severe pneumothorax. Mean TTI was significantly higher in pigs with pneumothorax compared to those without. The rate of ROSC was significantly lower in pigs with pneumothorax compared to those without (53% <em>vs</em> 83%). TTI increased progressively with the size of pneumothorax (mean TTI: 55 O no pneumothorax, <em>vs</em> 62 O mild-moderate <em>vs</em> 66 O severe pneumothorax). Rib fractures were present in all animals with mild-moderate and severe pneumothorax, and in 91% of those without. The total number of rib fractures was significantly higher in animals with severe pneumothorax compared to those without pneumothorax.</div></div><div><h3>Conclusion</h3><div>Pneumothorax causes TTI increases which are proportional to the size of the pneumothorax and ultimately reduce resuscitation success. High prevalence of chest skeletal injuries was observed in this study regardless of the presence of pneumothorax with higher amount of rib fractures in animals with severe pneumothorax. TTI measured by defibrillator can be used to detect the presence of pneumothorax during CPR. Future studies should explore this concept of TTI as a diagnostic tool, in order to improve resuscitation outcome in patients with pneumothorax.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100801"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.resplu.2024.100797
John A Stewart
Not applicable.
不适用。
{"title":"The elephant in the room: In-hospital resuscitation research is impeded by flawed time data","authors":"John A Stewart","doi":"10.1016/j.resplu.2024.100797","DOIUrl":"10.1016/j.resplu.2024.100797","url":null,"abstract":"<div><div>Not applicable.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100797"},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.resplu.2024.100794
Iana Meitlis , Jane Hall , Navya Gunaje , Megin Parayil , Betty Y Yang , Kyle Danielson , Catherine R Counts , Christopher Drucker , Charles Maynard , Thomas D Rea , Peter J. Kudenchuk , Michael R Sayre , Nicholas J Johnson
Introduction
We evaluated hospitals for variation in temperature control (TC) use after out-of-hospital cardiac arrest (OHCA) in a regional emergency medical services system and assessed association of hospital-level TC utilization with survival.
Methods
A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment.
Results
Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3–2.3]), witnessed arrest (OR: 1.6 [1.2–2.2]), and shockable rhythm (OR: 5.5 [3.9–7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4–0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital.
Conclusions
Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.
{"title":"Regional variation in temperature control after out-of-hospital cardiac arrest","authors":"Iana Meitlis , Jane Hall , Navya Gunaje , Megin Parayil , Betty Y Yang , Kyle Danielson , Catherine R Counts , Christopher Drucker , Charles Maynard , Thomas D Rea , Peter J. Kudenchuk , Michael R Sayre , Nicholas J Johnson","doi":"10.1016/j.resplu.2024.100794","DOIUrl":"10.1016/j.resplu.2024.100794","url":null,"abstract":"<div><h3>Introduction</h3><div>We evaluated hospitals for variation in temperature control (TC) use after out-of-hospital cardiac arrest (OHCA) in a regional emergency medical services system and assessed association of hospital-level TC utilization with survival.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment.</div></div><div><h3>Results</h3><div>Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3–2.3]), witnessed arrest (OR: 1.6 [1.2–2.2]), and shockable rhythm (OR: 5.5 [3.9–7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4–0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital.</div></div><div><h3>Conclusions</h3><div>Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100794"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.resplu.2024.100787
Qian Liu , Beibei Li , Siyi Zhou, Lulu Gu, Letian Xue, Ruyue Lu, Li Xu, Peng Sun
Aim
This study aimed to compare the quality of compressions in supine cardiopulmonary resuscitation (CPR) and prone CPR by performing chest compressions on a manikin. Evaluating the effect of prone CPR using different hand and body position on the quality of manual chest compressions and fatigue of participants.
Methods
After completing 2 min of chest compression in the supine position (Supine Group), 25 participants randomly performed three sets of 2-minutes chest compressions on a prone position manikin. Stand + hands overlapped Group: participants stood beside the patient bed with their hands overlapped and placed on the posterior segment of the thoracic spine between the scapulae, Straddle + hands separated Group: participants straddled the patient bed with their hands placed above the scapulae on both sides at the mid-chest level, and Straddle + hands overlapped Group: participants straddled the patient bed with their hands overlapping on the posterior segment of the thoracic spine between the scapulae. Subsequently, the quality of chest compressions and participants fatigue were assessed.
Results
Chest compression depth ratio and mean chest compression depth (MCCD) were worse in the three prone CPR groups (Stand + hands overlapped Group: 0.0(0.0,15.6) %, 39.8 ± 1.3 mm; Straddle + hands separated Group: 1.4(0.0,11.7) %, 42.4 ± 1.2 mm; Straddle + hands overlapped Group: 0.0(0.0,9.2) %, 40.9 ± 1.2 mm) than in the Supine group (87.1(68.1,94.0) %; p < 0.001, 52.4 ± 0.4 mm; p < 0.001). In the three prone CPR groups, Straddle + hands separated Group had the greatest MCCD, lowest changes in heart rate (p = 0.018) and lowest changes in RPE scores (p < 0.001). There were no significant differences between the four groups in terms of mean chest compression rate, accurate chest compression rate ratio, or correct recoil ratio.
Conclusion
This simulation-based study showed that the quality of chest compressions was worse in the prone position than in the supine position. When prone chest compressions were performed using different hand and body position, prone CPR performed by a participant straddling a hospital bed with hands placed above the scapula on either side at the mid-chest level provided higher-quality chest compressions and lower rescuer fatigue.
{"title":"The effect of hand and body position on chest compression quality and rescuer fatigue in prone cardiopulmonary resuscitation","authors":"Qian Liu , Beibei Li , Siyi Zhou, Lulu Gu, Letian Xue, Ruyue Lu, Li Xu, Peng Sun","doi":"10.1016/j.resplu.2024.100787","DOIUrl":"10.1016/j.resplu.2024.100787","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to compare the quality of compressions in supine cardiopulmonary resuscitation (CPR) and prone CPR by performing chest compressions on a manikin. Evaluating the effect of prone CPR using different hand and body position on the quality of manual chest compressions and fatigue of participants.</div></div><div><h3>Methods</h3><div>After completing 2 min of chest compression in the supine position (Supine Group), 25 participants randomly performed three sets of 2-minutes chest compressions on a prone position manikin. Stand + hands overlapped Group: participants stood beside the patient bed with their hands overlapped and placed on the posterior segment of the thoracic spine between the scapulae, Straddle + hands separated Group: participants straddled the patient bed with their hands placed above the scapulae on both sides at the mid-chest level, and Straddle + hands overlapped Group: participants straddled the patient bed with their hands overlapping on the posterior segment of the thoracic spine between the scapulae. Subsequently, the quality of chest compressions and participants fatigue were assessed.</div></div><div><h3>Results</h3><div>Chest compression depth ratio and mean chest compression depth (MCCD) were worse in the three prone CPR groups (Stand + hands overlapped Group: 0.0(0.0,15.6) %, 39.8 ± 1.3 mm; Straddle + hands separated Group: 1.4(0.0,11.7) %, 42.4 ± 1.2 mm; Straddle + hands overlapped Group: 0.0(0.0,9.2) %, 40.9 ± 1.2 mm) than in the Supine group (87.1(68.1,94.0) %; p < 0.001, 52.4 ± 0.4 mm; p < 0.001). In the three prone CPR groups, Straddle + hands separated Group had the greatest MCCD, lowest changes in heart rate (p = 0.018) and lowest changes in RPE scores (p < 0.001). There were no significant differences between the four groups in terms of mean chest compression rate, accurate chest compression rate ratio, or correct recoil ratio.</div></div><div><h3>Conclusion</h3><div>This simulation-based study showed that the quality of chest compressions was worse in the prone position than in the supine position. When prone chest compressions were performed using different hand and body position, prone CPR performed by a participant straddling a hospital bed with hands placed above the scapula on either side at the mid-chest level provided higher-quality chest compressions and lower rescuer fatigue.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100787"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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