Pub Date : 2025-01-11DOI: 10.1016/j.resplu.2025.100869
Christopher Schmitt , Gary Beasley , Karine Guerrier , Jennifer Kramer , Maryam Y. Naim , Heather Griffis , Bryan McNally , Paul S. Chan , Rabab Al-Araji , Joseph Rossano
Background
Out-of-hospital cardiac arrests (OHCA) increased in the adult population during the COVID pandemic.1,2,3,4,5,6,7,8
Objectives
We aimed to determine if OHCAs increased in the pediatric population during the COVID pandemic and whether the pandemic exacerbated pre-existing racial and socio-economic disparities.13,17,18,19,20
Methods
Utilizing data from 2015 to 2020 from the Cardiac Arrest Registry to Enhance Survival (CARES) database, 13,513 pediatric OHCAs were analyzed. Age categories included infants (0–<1 year), children (1–12 years) and adolescents (13–18 years). This included information on patient demographics, use of CPR (cardiopulmonary resuscitation) or AED (automatic external defibrillator), outcomes, COVID prevalence, and socioeconomic variables.
Results
In the pediatric population, there was no increase in OHCAs during the COVID pandemic, however in the adolescent population there was an increase in OHCA incidence from 0.29 to 0.40 arrests per 1 million total residents (p < 0.0001), and a decrease in the infant population from 0.861 to 0.803 events per 1 million total residents (p = 0.02). The pandemic worsened the burden of OHCAs in communities with lower socioeconomic status and in which COVID was more prevalent. Disparities of CPR or AED use and survival outcomes were seen based on race, sex, and socioeconomic factors, however none of these disparities were further augmented by the COVID pandemic.
Conclusions
Adolescent populations showed higher rates of OHCAs during the COVID pandemic, especially in areas with higher COVID incidence. Infants, however, had slightly decreased rates, which may be related to changes in other respiratory infections, and parental behavioral changes during the pandemic.
{"title":"COVID-19 and pediatric out-of-hospital cardiac arrest using U.S. registry database","authors":"Christopher Schmitt , Gary Beasley , Karine Guerrier , Jennifer Kramer , Maryam Y. Naim , Heather Griffis , Bryan McNally , Paul S. Chan , Rabab Al-Araji , Joseph Rossano","doi":"10.1016/j.resplu.2025.100869","DOIUrl":"10.1016/j.resplu.2025.100869","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrests (OHCA) increased in the adult population during the COVID pandemic.<sup>1,2,3,4,5,6,7,8</sup></div></div><div><h3>Objectives</h3><div>We aimed to determine if OHCAs increased in the pediatric population during the COVID pandemic and whether the pandemic exacerbated pre-existing racial and socio-economic disparities.<sup>13,17,18,19,20</sup></div></div><div><h3>Methods</h3><div>Utilizing data from 2015 to 2020 from the Cardiac Arrest Registry to Enhance Survival (CARES) database, 13,513 pediatric OHCAs were analyzed. Age categories included infants (0–<1 year), children (1–12 years) and adolescents (13–18 years). This included information on patient demographics, use of CPR (cardiopulmonary resuscitation) or AED (automatic external defibrillator), outcomes, COVID prevalence, and socioeconomic variables.</div></div><div><h3>Results</h3><div>In the pediatric population, there was no increase in OHCAs during the COVID pandemic, however in the adolescent population there was an increase in OHCA incidence from 0.29 to 0.40 arrests per 1 million total residents (<em>p</em> < 0.0001), and a decrease in the infant population from 0.861 to 0.803 events per 1 million total residents (<em>p</em> = 0.02). The pandemic worsened the burden of OHCAs in communities with lower socioeconomic status and in which COVID was more prevalent. Disparities of CPR or AED use and survival outcomes were seen based on race, sex, and socioeconomic factors, however none of these disparities were further augmented by the COVID pandemic.</div></div><div><h3>Conclusions</h3><div>Adolescent populations showed higher rates of OHCAs during the COVID pandemic, especially in areas with higher COVID incidence. Infants, however, had slightly decreased rates, which may be related to changes in other respiratory infections, and parental behavioral changes during the pandemic.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100869"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160250","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 : 2025-01-01DOI: 10.1016/j.resplu.2024.100840
Mirza Noor Ali Baig , Zafar Fatmi , Nadeem Ullah Khan , Uzma Rahim Khan , Ahmed Raheem , Junaid Abdul Razzak
Background
Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).
Aim
To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.
Methods
Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.
Results
Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission.
Conclusion
This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.
{"title":"Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study","authors":"Mirza Noor Ali Baig , Zafar Fatmi , Nadeem Ullah Khan , Uzma Rahim Khan , Ahmed Raheem , Junaid Abdul Razzak","doi":"10.1016/j.resplu.2024.100840","DOIUrl":"10.1016/j.resplu.2024.100840","url":null,"abstract":"<div><h3>Background</h3><div>Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).</div></div><div><h3>Aim</h3><div>To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.</div></div><div><h3>Methods</h3><div>Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh<strong>.</strong> Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.</div></div><div><h3>Results</h3><div>Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission.</div></div><div><h3>Conclusion</h3><div>This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100840"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981088","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 : 2025-01-01DOI: 10.1016/j.resplu.2024.100851
Tomás Barry , Garrett Greene , Martin Quinn , Conor Deasy , Gerard Bury , Siobhan Masterson , Andrew W Murphy , Out-of-Hospital Cardiac Arrest Registry Steering Group
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.
{"title":"Out-of-Hospital Cardiac Arrest in Ireland 2012 to 2020: Bystander CPR, bystander defibrillation and survival in the Utstein comparator group","authors":"Tomás Barry , Garrett Greene , Martin Quinn , Conor Deasy , Gerard Bury , Siobhan Masterson , Andrew W Murphy , Out-of-Hospital Cardiac Arrest Registry Steering Group","doi":"10.1016/j.resplu.2024.100851","DOIUrl":"10.1016/j.resplu.2024.100851","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100851"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019214","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 : 2025-01-01DOI: 10.1016/j.resplu.2024.100824
Samantha Boggs , James Dayre McNally , Katie O’Hearn , Michael Del Bel , Jennifer Armstrong , Dennis Newhook , Anna-Theresa Lobos
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.
{"title":"Teaching high quality paediatric basic life support to laypeople: The development and evaluation of a virtual simulation game","authors":"Samantha Boggs , James Dayre McNally , Katie O’Hearn , Michael Del Bel , Jennifer Armstrong , Dennis Newhook , Anna-Theresa Lobos","doi":"10.1016/j.resplu.2024.100824","DOIUrl":"10.1016/j.resplu.2024.100824","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100824"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981062","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}
Out-of-hospital cardiac arrest (OHCA) affects approximately 46,000 people in France annually and survival remains low. There is no published data specific to the characteristics and outcomes of OHCA in French overseas territories, especially in the French Caribbean territories. The aim of this study was to describe the characteristics and outcomes of adult OHCA patients managed by the Emergency Medical Service team (EMS) in Martinique.
Methods
All adults with OHCA, managed by the EMS of Martinique between January 1st 2018 and June 30th 2019, were included. Primary outcome was 30 day-survival and neurological outcome at 30 days assessed by the Cerebral Performance Category scale (CPC). Secondary outcomes were return of spontaneous circulation (ROSC) prior to hospital admission and causes of cardiac arrest in patients with ROSC.
Results
This study included 340 OHCA patients. The population was predominantly male (64%), with a median age of 68 [54–78] years. OHCA resulted from a medical condition in 314 patients (92%) and occurred mainly at home (75%), in the presence of witnesses for 235 patients (69%). Basic life support was initiated in 174 OHCA (51%). Median time to first-responders’ and prehospital mobile intensive care unit’s arrivals at scene were 17 [10–30] and 27 [19–41] minutes after call to the EMS dispatching center for OHCA. Non-shockable initial rhythm was present in 315 patients (93%), and 240 patients (71%) received advanced life support. Thirty-one patients (9%) achieved ROSC. On day 30, 13 patients (3.8%) were still alive, and 8 of them (2.4%) were alive with a CPC score of 1 or 2.
Conclusion
The overall adult OHCA survival rate and survival with good neurological status on day-30 in the French Caribbean island of Martinique are low. OHCA survival rate may be improved by educating the population on basic life support techniques and reducing the time responses for first-responders and prehospital mobile intensive care unit to reach patients.
{"title":"Outcome from out-of-hospital cardiac arrest managed by the pre-hospital emergency medical system in Martinique, a French Caribbean Overseas Territory","authors":"Florian Negrello , Jonathan Florentin , Romain Jouffroy , Vianney Aquilina , Rishika Banydeen , Rémi Neviere , Dabor Resiere , Moustapha Drame , Papa Gueye","doi":"10.1016/j.resplu.2024.100847","DOIUrl":"10.1016/j.resplu.2024.100847","url":null,"abstract":"<div><h3>Introduction</h3><div>Out-of-hospital cardiac arrest (OHCA) affects approximately 46,000 people in France annually and survival remains low. There is no published data specific to the characteristics and outcomes of OHCA in French overseas territories, especially in the French Caribbean territories. The aim of this study was to describe the characteristics and outcomes of adult OHCA patients managed by the Emergency Medical Service team (EMS) in Martinique.</div></div><div><h3>Methods</h3><div>All adults with OHCA, managed by the EMS of Martinique between January 1st 2018 and June 30th 2019, were included. Primary outcome was 30 day-survival and neurological outcome at 30 days assessed by the Cerebral Performance Category scale (CPC). Secondary outcomes were return of spontaneous circulation (ROSC) prior to hospital admission and causes of cardiac arrest in patients with ROSC.</div></div><div><h3>Results</h3><div>This study included 340 OHCA patients. The population was predominantly male (64%), with a median age of 68 [54–78] years. OHCA resulted from a medical condition in 314 patients (92%) and occurred mainly at home (75%), in the presence of witnesses for 235 patients (69%). Basic life support was initiated in 174 OHCA (51%). Median time to first-responders’ and prehospital mobile intensive care unit’s arrivals at scene were 17 [10–30] and 27 [19–41] minutes after call to the EMS dispatching center for OHCA. Non-shockable initial rhythm was present in 315 patients (93%), and 240 patients (71%) received advanced life support. Thirty-one patients (9%) achieved ROSC. On day 30, 13 patients (3.8%) were still alive, and 8 of them (2.4%) were alive with a CPC score of 1 or 2.</div></div><div><h3>Conclusion</h3><div>The overall adult OHCA survival rate and survival with good neurological status on day-30 in the French Caribbean island of Martinique are low. OHCA survival rate may be improved by educating the population on basic life support techniques and reducing the time responses for first-responders and prehospital mobile intensive care unit to reach patients.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100847"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070612","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 : 2025-01-01DOI: 10.1016/j.resplu.2025.100867
Maria Luce Caputo , Giuliana Monachino , Ruggero Cresta , Alessia Currao , Enrico Baldi , Simone Savastano , Andrea Cortegiani , Mariachiara Ippolito , Sara Accetta , Alessandra Gargano , Camilla Metelmann , Bibiana Metelmann , Carlos Ramon Hölzing , Julian Ganter , Michael Patrick Müller , Claudio Benvenuti , Stefania Tomola , Pierangelo Pinetti , Pier Luigi Ingrassia , Francesca Dalia Faraci , Angelo Auricchio
Background and trial design
Outcomes of out-of-hospital cardiac arrest vary significantly, often due to the quality of cardiopulmonary resuscitation (CPR) provided. Automated real-time feedback devices have been explored to enhance CPR skills, but few devices currently ensure proper chest recoil. This study aimed to assess whether a double-click metronome could improve chest compressions (CC) metrics and particularly CC release velocity (CCRV) during CPR manikin simulation.
Methods
We developed and tested a double-click metronome for CPR, where the first click signals the compression and the second click marks the end of chest release. We performed a multicenter non-blinded, randomized, controlled trial including volunteers with different levels of CPR expertise. Three CC metrics—depth, rate, and CCRV—were measured using an automated external defibrillator equipped with pads for CPR quality analysis.
Results
503 volunteers participated in the study, with 54% being male and a mean age of 34 ± 12 years. The median CCRV and CC depth achieved with the double-click metronome were significantly higher compared to the standard metronome (median difference 6 mm/s, IQR-15.2, 28.5, +1.5%, p < 0.001; median difference 0.1 cm, +2.5%, IQR −0.1, 0.4, p < 0.001). The double-click metronome led to significant improvements in CC depth and CCRV across all volunteer categories, with the greater effect observed in first responders and in non-specialized healthcare personnel.
Conclusions
Compared to a standard metronome, the double-click metronome significantly enhances CPR quality. If further validated in real resuscitations, this new audio prompt could be a valuable tool for integration into devices designed for out-of-hospital cardiac arrest resuscitation, as well as a training tool to improve CPR quality.
{"title":"Release velocity ImprovemenT with a new Metronome guIding chest COmpressions: The RITMICO simulation study","authors":"Maria Luce Caputo , Giuliana Monachino , Ruggero Cresta , Alessia Currao , Enrico Baldi , Simone Savastano , Andrea Cortegiani , Mariachiara Ippolito , Sara Accetta , Alessandra Gargano , Camilla Metelmann , Bibiana Metelmann , Carlos Ramon Hölzing , Julian Ganter , Michael Patrick Müller , Claudio Benvenuti , Stefania Tomola , Pierangelo Pinetti , Pier Luigi Ingrassia , Francesca Dalia Faraci , Angelo Auricchio","doi":"10.1016/j.resplu.2025.100867","DOIUrl":"10.1016/j.resplu.2025.100867","url":null,"abstract":"<div><h3>Background and trial design</h3><div>Outcomes of out-of-hospital cardiac arrest vary significantly, often due to the quality of cardiopulmonary resuscitation (CPR) provided. Automated real-time feedback devices have been explored to enhance CPR skills, but few devices currently ensure proper chest recoil. This study aimed to assess whether a double-click metronome could improve chest compressions (CC) metrics and particularly CC release velocity (CCRV) during CPR manikin simulation.</div></div><div><h3>Methods</h3><div>We developed and tested a double-click metronome for CPR, where the first click signals the compression and the second click marks the end of chest release. We performed a multicenter non-blinded, randomized, controlled trial including volunteers with different levels of CPR expertise. Three CC metrics—depth, rate, and CCRV—were measured using an automated external defibrillator equipped with pads for CPR quality analysis.</div></div><div><h3>Results</h3><div>503 volunteers participated in the study, with 54% being male and a mean age of 34 ± 12 years. The median CCRV and CC depth achieved with the double-click metronome were significantly higher compared to the standard metronome (median difference 6 mm/s, IQR-15.2, 28.5, +1.5%, <em>p</em> < 0.001; median difference 0.1 cm, +2.5%, IQR −0.1, 0.4, <em>p</em> < 0.001). The double-click metronome led to significant improvements in CC depth and CCRV across all volunteer categories, with the greater effect observed in first responders and in non-specialized healthcare personnel.</div></div><div><h3>Conclusions</h3><div>Compared to a standard metronome, the double-click metronome significantly enhances CPR quality. If further validated in real resuscitations, this new audio prompt could be a valuable tool for integration into devices designed for out-of-hospital cardiac arrest resuscitation, as well as a training tool to improve CPR quality.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100867"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082675","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 : 2025-01-01DOI: 10.1016/j.resplu.2024.100841
Louise Kollander Jakobsen , Victor Kjærulf , Janet Bray , Theresa Mariero Olasveengen , Fredrik Folke , on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force
Aim
Out-of-hospital cardiac arrest (OHCA) remains a critical health concern, where prompt access to automated external defibrillators (AEDs) significantly improves survival. This scoping review broadly investigates the feasibility and impact of dronedelivered AEDs for OHCA response. Methods: PubMed, Cochrane, and Web of Science were searched from inception to August 6, 2024, with eligibility broadly including empirical data. The charting process involved iterative data extraction for thematic analysis. Results: We identified 306 titles and, after duplicate removal, title/abstract screening, and full text review, included 39 studies. These were divided into three categories: 1) Real-world observational studies (n = 3), 2) Test flights/simulation studies and qualitative analyses (n = 15), and 3) Computer/prediction models (n = 21). Real-world studies demonstrated the feasibility of drone AED delivery, with a time advantage of 01:52 – 03:14 min over ambulances observed in 64–67 % of cases. Test flight/simulation and qualitative studies consistently reported feasibility and positive bystander experiences. Computer/prediction models exhibited considerable heterogeneity, yet all indicated significant time savings for AED delivery compared to traditional EMS methods. Moreover, seven studies estimated improved survival rates, with five assessing cost-effectiveness and favouring drone systems. Regional factors such as EMS response times, volunteer responder programmes, terrain, weather, and budget constraints influenced the system’s effectiveness. Conclusion: Across all categories, studies confirmed the feasibility of drone-delivered AED systems, with significant potential for reducing time to AED arrival compared to EMS arrival. Prediction models suggested enhanced survival alongside costeffectiveness. Further research, including more extensive real-world studies and regulatory advancements, is imperative to integrate drones effectively into OHCA response systems.
{"title":"Drones delivering automated external defibrillators for out-of-hospital cardiac arrest: A scoping review","authors":"Louise Kollander Jakobsen , Victor Kjærulf , Janet Bray , Theresa Mariero Olasveengen , Fredrik Folke , on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force","doi":"10.1016/j.resplu.2024.100841","DOIUrl":"10.1016/j.resplu.2024.100841","url":null,"abstract":"<div><h3>Aim</h3><div>Out-of-hospital cardiac arrest (OHCA) remains a critical health concern, where prompt access to automated external defibrillators (AEDs) significantly improves survival. This scoping review broadly investigates the feasibility and impact of dronedelivered AEDs for OHCA response. Methods: PubMed, Cochrane, and Web of Science were searched from inception to August 6, 2024, with eligibility broadly including empirical data. The charting process involved iterative data extraction for thematic analysis. Results: We identified 306 titles and, after duplicate removal, title/abstract screening, and full text review, included 39 studies. These were divided into three categories: 1) Real-world observational studies (n = 3), 2) Test flights/simulation studies and qualitative analyses (n = 15), and 3) Computer/prediction models (n = 21). Real-world studies demonstrated the feasibility of drone AED delivery, with a time advantage of 01:52 – 03:14 min over ambulances observed in 64–67 % of cases. Test flight/simulation and qualitative studies consistently reported feasibility and positive bystander experiences. Computer/prediction models exhibited considerable heterogeneity, yet all indicated significant time savings for AED delivery compared to traditional EMS methods. Moreover, seven studies estimated improved survival rates, with five assessing cost-effectiveness and favouring drone systems. Regional factors such as EMS response times, volunteer responder programmes, terrain, weather, and budget constraints influenced the system’s effectiveness. Conclusion: Across all categories, studies confirmed the feasibility of drone-delivered AED systems, with significant potential for reducing time to AED arrival compared to EMS arrival. Prediction models suggested enhanced survival alongside costeffectiveness. Further research, including more extensive real-world studies and regulatory advancements, is imperative to integrate drones effectively into OHCA response systems.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100841"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985399","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 : 2025-01-01DOI: 10.1016/j.resplu.2024.100845
Immaculate Nakitende , Joan Nabiryo , Andrew Muhumuza , Franck Katembo Sikakulya , John Kellett , Kitovu Hospital Study Group
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.
背景：虽然几个世纪以来人们已经认识到外周皮肤温度与感染、严重疾病和死亡的关联，但很少有研究将这一发现与其他疾病严重程度的床边指标进行明确比较。本研究将主观评估的前臂背侧皮肤温度和湿度与疾病严重程度的其他指标进行比较。方法：对乌干达一家资源匮乏的医院收治的急症患者进行非介入性观察研究，研究主观评估的前臂背侧皮肤温度和其他床边表现与24小时内死亡的关系。结果：653例住院患者有2104次观察；在239次观察中，前臂背侧皮肤主观感觉异常热或冷，这一发现与24小时死亡率相关（优势比4.48,95% CI 1.89-10.46）；这种增加的死亡风险与呼吸急促、缺氧和休克指数>.0相关的死亡风险增加相当，但明显低于Kitovu快速分类评分>.0相关的死亡风险增加。当根据温度和湿度进行分层时，“又冷又湿”和“又热又湿”的皮肤与较高的早期预警得分相关。前臂皮肤冷或热对24小时死亡率的特异性为0.83，但敏感性仅为0.34；因此，它的缺失并不排除即将死亡的可能性。结论：触摸和感觉皮肤温度和湿度是一种有价值的临床体征，可以在床边快速确定。然而，虽然它具有高特异性，但对即将死亡的敏感性较低。
{"title":"A pilot observational study of the association of 24-hour mortality with the subjective assessment of the forearm skin temperature and moisture compared to other bedside indicators of illness severity","authors":"Immaculate Nakitende , Joan Nabiryo , Andrew Muhumuza , Franck Katembo Sikakulya , John Kellett , Kitovu Hospital Study Group","doi":"10.1016/j.resplu.2024.100845","DOIUrl":"10.1016/j.resplu.2024.100845","url":null,"abstract":"<div><h3>Background</h3><div>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,</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100845"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985935","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 : 2025-01-01DOI: 10.1016/j.resplu.2025.100865
J. Gould , R.A. Marshall , D. French , M. Dyer-Heynen , P. Olszynski
Background
The lower half of the sternum is currently recommended as the area of compression (AOC) in CPR. Compressions over this area often result in outflow obstruction and inadequate compression of the left ventricle. Alternative left-sided chest compressions that target the left ventricle may improve cardiac arrest outcomes. However, little is known about the risks of thoracoabdominal injuries or the biomechanics of left-sided compressions.
Methods
The objective of this study was to examine the thoracoabdominal injury patterns and compression biomechanics during standard (control) and left-sided (experimental; off sternum, patient left, 6th rib) chest compressions. N = 6 clinical-grade cadavers (control n = 2; experimental n = 4) underwent six 2-minute rounds of chest compressions with intermittent fluoroscopy. Chest compression depth, recoil, and rate were standardized using compression feedback devices. Post-CPR dissection was used to examine for thoracoabdominal injuries.
Results
Standard compressions resulted in rib fractures (n = 1 [50%]). Left-sided compressions resulted in rib fractures (n = 4 [100%]), flail chest segments (n = 3 [75%]), and internal thoracic artery injury (n = 1 [25%]). No abdominal organ injuries were identified in either group (N = 6 [0%]). During compression, each condition yielded a different pattern of chest wall deformity (standard − regular trapezoid [midline, comparable left–right sides, flat top, and bottom]; left-sided − irregular trapezium [left-sided, unequal sides, leftward sloped top]).
Conclusion
Experimental left-sided compressions consistently produced rib fractures and flail chest segments. Findings should be interpreted with caution due to the limited sample size. Further studies investigating the biomechanics and outcomes of left sided chest compressions are warranted.
{"title":"Comparing sternal versus left-sided chest compressions for thoracoabdonimal injuries and compression biomechanics: A clinical-grade cadaver study","authors":"J. Gould , R.A. Marshall , D. French , M. Dyer-Heynen , P. Olszynski","doi":"10.1016/j.resplu.2025.100865","DOIUrl":"10.1016/j.resplu.2025.100865","url":null,"abstract":"<div><h3>Background</h3><div>The lower half of the sternum is currently recommended as the area of compression (AOC) in CPR. Compressions over this area often result in outflow obstruction and inadequate compression of the left ventricle. Alternative left-sided chest compressions that target the left ventricle may improve cardiac arrest outcomes. However, little is known about the risks of thoracoabdominal injuries or the biomechanics of left-sided compressions.</div></div><div><h3>Methods</h3><div>The objective of this study was to examine the thoracoabdominal injury patterns and compression biomechanics during standard (control) and left-sided (experimental; off sternum, patient left, 6th rib) chest compressions. N = 6 clinical-grade cadavers (control n = 2; experimental n = 4) underwent six 2-minute rounds of chest compressions with intermittent fluoroscopy. Chest compression depth, recoil, and rate were standardized using compression feedback devices. Post-CPR dissection was used to examine for thoracoabdominal injuries.</div></div><div><h3>Results</h3><div>Standard compressions resulted in rib fractures (n = 1 [50%]). Left-sided compressions resulted in rib fractures (n = 4 [100%]), flail chest segments (n = 3 [75%]), and internal thoracic artery injury (n = 1 [25%]). No abdominal organ injuries were identified in either group (N = 6 [0%]). During compression, each condition yielded a different pattern of chest wall deformity (standard − regular trapezoid [midline, comparable left–right sides, flat top, and bottom]; left-sided − irregular trapezium [left-sided, unequal sides, leftward sloped top]).</div></div><div><h3>Conclusion</h3><div>Experimental left-sided compressions consistently produced rib fractures and flail chest segments. Findings should be interpreted with caution due to the limited sample size. Further studies investigating the biomechanics and outcomes of left sided chest compressions are warranted.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100865"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082733","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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