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In 2023, the medical journal Resuscitation published the results of the latest study by Sam Parnia and his team, the AWARE II, in which they aimed to study consciousness after cardiac arrest and during the resuscitation process. Once again, the main objective was to detect any near-death experience (NDE) in which explicit memories occurred, either visual--of hidden images--or auditory. An important novelty was the measurement of EEG and cerebral oximetry during the brief pauses of CPR. Out of 28 interviews the researchers conducted with survivors, six patients reported NDEs, but none of them explicitly recalled either the hidden images or the auditory stimuli. However, in other patients from the study, some EEG activity that the authors deemed "compatible with consciousness" was detected during resuscitation, at least in some frequencies and brain areas. These data reopened the debate about whether the lucid consciousness of NDEs is generated by the dying brain. Parnia's own reflections in his earlier Bigelow contest essay denied this possibility. The AWARE II results did not resolve this question, but Parnia and his team suggested a possible explanation, still very theoretical, of NDEs based on brain disinhibition and ac-tivation of dormant brain circuits that would give access to "new dimensions of reality". [ABSTRACT FROM AUTHOR]

• The disparities in bystander resuscitation and clinical outcomes betwwen Black, Hispanic, Asian and Non-Hispanic White OHCAs were comprehensive evaluated. • Resusciatation measures includE CPR, CPR with ventilation, application of AED/defibrillator, and delivery of shocks. • Clinical outcomes of OHCAs was conducted across 5 aspects, including death at the sceneor en route, status upon first arrival at ED, survival until ED or hospital discharge, and favorable neurogical outcome at discharge. Bystander-provided cardiopulmonary resuscitation (CRP) influences the survival rates of out-of-hospital cardiac arrests (OHCAs). Disparities on bystander resuscitation measures between Black, Hispanic, Asians and Non-Hispanic White OHCAs is unclear. Examining racial and ethnic differences in bystander resuscitations is essential to better target interventions. 15,542 witnessed OHCAs were identified between April 1, 2011, and June 30, 2015 using the Resuscitation Outcomes Consortium Epidemiologic Registry 3, a multi-center, controlled trial about OHCAs in the United States and Canada. Multivariable logistic regression model was used to analyze the differences in bystander resuscitation (bystander CRP [B-CPR], CPR plus ventilation, automated external defibrillators/defibrillator application [B-AED/D], or delivery of shocks) and clinical outcomes (death at the scene or en route, return of spontaneous circulation upon first arrival at the emergency department [ROSC-ED], survival until ED discharge [S-ED], survival until hospital discharge [S-HOS], and favorable neurological outcome at discharge) between Black, Hispanic, or Asian victims and Non-Hispanic White victims. Compared to OHCA victims in Non-Hispanic Whites, Black, Hispanic, and Asians were less likely to receive B-CPR (adjusted OR: 0.79; 95 % CI: 0.63–0.99), and B-AED/D (adjusted OR: 0.80; 95 % CI: 0.65–0.98) in public locations. And, Black, Hispanic, and Asian OHCAs were less likely to receive bystander resuscitation in street/highway locations and public buildings, and less likely to have better clinical outcomes, including ROSC-ED, S-ED and S-HOS. Black, Hispanic and Asian victims with witnessed OHCAs are less likely to receive bystander resuscitation and more likely to get worse outcomes than Non-Hispanic White victims. [ABSTRACT FROM AUTHOR]

The Lazarus phenomenon or autoresuscitation (autoROSC) is the return of spontaneous circulation (ROSC) after the termination of the cardiopulmonary resuscitation (CPR) efforts. The purpose of the current scoping review is to present the available data in the literature regarding autoROSC. We reviewed four scientific databases to identify all studies which reported autoROSC cases in patients who underwent CPR. We then extracted all information relevant to CPR and autoROSC. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We identified 66 studies describing 76 autoROSC cases. The majority of cardiac arrests were in-hospital (44, 57.89%). Median time from termination of CPR to autoROSC was 5 min. Regarding the outcome, 52 (77.61%) patients died and 11 (14.47%) patients had intact neurological outcome. A higher mortality rate was identified in patients with respiratory comorbidities. Overall, 24 (31.58%) patients survived. AutoROSC is probably an under-reported event in the medical community. Healthcare professionals should be aware of the phenomenon and actively monitor for it, when appropriate. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a marked increase in the incidence of in-hospital cardiac arrest (IHCA), with mortality rates surpassing 90% despite cardiopulmonary resuscitation (CPR) efforts. Patients with COVID-19 who experience IHCA are less likely to present with shockable rhythms, have lower rates of return of spontaneous circulation (ROSC), and exhibit significantly lower survival rates. The aim of this paper was to investigate the epidemiology and clinical features of COVID-19 patients who required CPR following an episode of IHCA. Study design and methods: Retrospective analysis of adult patients aged 18 years or older, who were admitted to our critical care unit and diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using reverse transcription polymerase chain reaction (rtPCR) between March 2020 and February 2022. Patients who experienced IHCA at any point during their hospital stay were included in the study. Data were collected for demographics, pre-admission conditions, comorbidities, resuscitation records, severity scores (such as Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II, and Ichikado CT), laboratory results, length of stay, and survival to hospital discharge. Results: Nine hundred and ninety-four patients with a COVID-19 diagnosis were admitted to our high-acuity COVID-19 unit during the study period. Out of those, 129 patients underwent CPR. The median age was 63 years old (52-72). Ninetyone (70.5%) patients were male. Sixty-five (50.8%) patients were Hispanic, 34 (26.6%) Caucasian, 22 (17.2%) African American, and 7 (5.5%) other races. The most common comorbidities were systemic arterial hypertension (48.4%) and diabetes mellitus (32%). Thirty-nine patients (30.5%) had no reported comorbidities. The mean APACHE score was 16 (11-23), and the highest APACHE score during hospitalization was 29 (21.5-35). The mean SOFA score was 4 (2-6.5), with the highest SOFA score during hospitalization being 10 (7-13). The mean Ichikado CT score was 200 (150-245) and an Ichikado CT score >174 was present in 68 (63.6%) patients. Twenty-one (16.3%) patients developed pulmonary embolism, 7 (5.4%) patients developed myocarditis, 22 (17.1%) developed acute kidney injury, and 40 (31%) patients developed disseminated intravascular coagulation (DIC). The most frequent cardiac arrest rhythm was asystole (9.8%), followed by pulseless electrical activity (PEA) (2.6%), pulseless ventricular tachycardia (0.5%), and ventricular fibrillation (0.6%). The mean CPR duration was 22.8 minutes. The mortality of patients that underwent CPR was 98.4%. Conclusions: Most COVID-19 patients who received CPR in this cohort had a severe disease course, with a low survival rate and a short mean survival time. Our findings revealed that male gender, age above 65 years, hospital admission more than 7.5 days after symptom onset, high scores on admission for severity assessment such as APACHE II and SOFA, as well as high levels of creatine phosphokinase (CPK), blood urea nitrogen: creatinine (BUN:Cr) ratio, interleukin 6 (IL- 6), and glucose upon admission, and the presence of a cytokine storm at the time of admission were all factors associated with an increased risk of mortality following CPR. [ABSTRACT FROM AUTHOR]

The success of the manual pulse check method frequently employed during cardiopulmonary resuscitation (CPR) is controversial due to its subjective, patient- and operator-dependent, and time-consuming nature. Carotid ultrasound (c-USG) has recently emerged as an alternative, although there are still insufficient studies on the subject. The purpose of the present study was to compare the success of the manual and c-USG pulse check methods during CPR. This prospective observational study was conducted in the critical care area of a university hospital emergency medicine clinic. Pulse checks in patients with non-traumatic cardiopulmonary arrest (CPA) undergoing CPR were performed using the c-USG method from one carotid artery and the manual method from the other. The gold standard in the decision regarding return of spontaneous circulation (ROSC) was the clinical judgment made using the rhythm on the monitor, manual femoral pulse check, end tidal carbon dioxide (ETCO 2), and cardiac USG instruments. The success in predicting ROSC and measurement times of the manual and c-USG methods were compared. The success of both methods was calculated as sensitivity and specificity, and the clinical significance of the difference between the methods' sensitivity and specificity was evaluated Newcombe's method. A total of 568 pulse measurements were performed on 49 CPA cases using both c-USG and the manual method. The manual method exhibited 80% sensitivity and 91% specificity in predicting ROSC (+PV: 35%, −PV: 64%), while c-USG exhibited 100% sensitivity and 98% specificity (+PV: 84%, −PV: 100%). The difference in sensitivities between the c-USG and manual methods was −0.0704 (95% CI: −0.0965; −0.0466), and the difference between their specificities was 0.0106 (95% CI: 0.0006; 0.0222). The difference between the specificities and sensitivities was statistically significant at analysis performed adopting the clinical judgment of the team leader using multiple instruments as the gold standard. The manual method yielded an ROSC decision in 3 ± 0.17 s and c-USG in 2.8 ± 0.15 s, the difference being statistically significant. According to the results of this study, the pulse check method with c-USG may be superior to the manual method in terms of fast and accurate decision making in CPR. [ABSTRACT FROM AUTHOR]

Cardiac-related deaths are the leading nontraumatic cause of death in the young athlete. Although there are multiple causes for cardiac arrest in athletes, sideline evaluation and management does not vary. Recognition, immediate high-quality chest compressions, and time to defibrillation are the greatest factors affecting survival. This article reviews the approach to the collapsed athlete, causes for select cardiac emergencies in athletes, preparedness for cardiac emergencies, and return to play considerations and recommendations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to investigate the effect of the endometrial thickness (EMT) measured on embryo transfer day on clinical pregnancy (CPR), live birth (LBR), and miscarriage rates (MR) in fresh and frozen-thawed embryo transfer cycles. PATIENTS AND METHODS: This prospective cohort study consisted of 160 patients, 80 frozen-thawed and 80 fresh cycles. Endometrial thickness was measured on the day of embryo transfer for fresh and frozen cycles. In addition to the endometrial thickness, the endometrial appearances of the patients in both groups were also recorded. Those without trilaminar appearance were excluded from the study. Both groups were classified according to the EMT values measured on the day of the transfer. The number of groups was calculated considering 1 mm intervals of EMT, and a total of 8 groups were formed. The initial group started with <6 mm, while the final group was >12 mm. The relationship between endometrial thickness, clinical pregnancy, live birth and miscarriage rates was analyzed using multivariable regression analysis. RESULTS: A significant correlation was observed between endometrial thickness values, clinical pregnancy rates, live birth rates in the analyses performed after adjusting for age, infertility duration, body mass index, number of MII oocytes, number and quality of embryos transferred. Based on univariate analysis, each 1 mm increase in EMT resulted in a significant increase in CPR (OR=1.08, 95% CI: 1.07-1.09, p<0.01). Similarly, the increase in EMT led to a significant increase in LBR (OR=1.12, 95% CI: 1.10-1.14, p<0.01). Although the relationship between miscarriage rates and EMT is not as clear as LBR and CPR, the increase in EMT led to a significant reduction in MR (OR=1.05, 95% CI: 1.03- 1.05, p=0.03). The lowest CPR was detected at EMT <6 mm, while the EMT value with the highest CPR was 11-12 mm in both groups. Likewise, in both groups, the lowest LBR was detected at EMT <6 mm, while the EMT value with the highest LBR was 11-12 mm. Although MR showed a fluctuating course according to EMT values, it reached its highest rate at EMT <6 mm (100%). In EMT 11-12 mm, MR reached its lowest level (12.5%). If EMT >12 mm, an increase in MR rates was observed again (33.3%). CONCLUSIONS: Clinical pregnancy and live birth rates remain optimal if the endometrial thickness is between 11-12 mm in both fresh and frozen-thawed cycles. A fluctuating course is observed between EMT values and miscarriage rates. [ABSTRACT FROM AUTHOR]

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• Deliberate practice activities can improve learner competence and performance. • Deliberate practice was integrated into CPR learner activities as a QI initiative. • Repetition of deliberate practice actions can apply to any health care discipline. Deliberate practice offers a foundation for learning experiences based on real-life situations through repetition. Single demonstrations of a skill are often ineffective in determining mastery in undergraduate nursing students. Ninety-eight fourth-semester learners enrolled in the critical care course of a pre-baccalaureate program. A deliberate practice approach to learning was implemented in a fourth-semester undergraduate nursing course to evaluate learner knowledge, skills, and performance, as a quality improvement initiative. Multiple activities comprised of skills stations, lecture, an ECG review, and a simulation-based experience were used to allow learners to gain mastery. Evidence revealed that a combined SBE in classroom and simulation lab help learners retain knowledge. Learners reported this approach also improved their ability to critically think and confidence in performance. The implementation of deliberate practice in the simulation environment allows for exposure to real life circumstances in a controlled atmosphere, helping learners preserve information and understanding. [ABSTRACT FROM AUTHOR]

• Multiple code patients had higher in-hospital mortality • Multiple codes within 24 hours led to significantly higher in-hospital mortality • Patients sustaining a neurologic event were more likely to have a non-home discharge Cardiopulmonary resuscitation (CPR) is widely used in response to cardiac arrest. However, little is known regarding outcomes for those who undergo multiple episodes of cardiac arrest while in the hospital. The purpose of this study was to evaluate the association of multiple cardiac events with in-hospital mortality for patients admitted to our tertiary care hospital who underwent multiple code events. We performed a retrospective cohort study on all patients who underwent cardiac arrest from 2012 to 2016. Primary outcome was survival to discharge. Secondary outcomes included post-cardiac-arrest neurologic events (PCANE), non-home discharge, and one-year mortality. There were 622 patients with an overall mortality rate of 78.0%. Patients undergoing CPR for cardiac arrest once during their admission had lower in-hospital mortality rates compared to those that had multiple (68.9% versus 91.3%, p <.01). Subset analysis of those who had multiple episodes of CPR revealed that more than one event within a 24-hour period led to significantly higher in-hospital mortality rates (94.7% versus 74.4%, p <.01). Other variables associated with in-hospital mortality included body mass index, female sex, malignancy, and increased down time per code. Patients that had a non-home discharge were more likely to have sustained a PCANE than those that were discharged home (31.4% versus 3.9%, p <.01). A non-home discharge was associated with higher one-year mortality rates compared to a home discharge (78.4% versus 54.3%, p =.01). Multiple codes within a 24-hour period and the average time per code were associated with in-hospital mortality in cardiac arrest patients. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation (CPR) improves immediate survival and survival to discharge in patients with cardiac arrest in hospital. Without frequent retraining in CPR, healthcare providers may lose their skills and knowledge earlier than the recommendation of CPR retraining every two years. To determine the competencies of doctors at an academic hospital regarding CPR training, knowledge, experience and perceptions. A custom-designed questionnaire reviewed by CPR providers was distributed to doctors to obtain information on CPR training, exposure to and perceptions of CPR retraining, and CPR knowledge. The knowledge component of the questionnaire comprised questions on basic, advanced cardiac, paediatric, neonatal and obstetric life support. Of the 245 participants, 22.5% achieved competency (a mark of ≥ 80%) for the knowledge component of the questionnaire. The majority of participants had not undertaken retraining after two years, although 96.7% of participants felt that keeping up-to-date with CPR guidelines would improve patient outcomes. The most common reasons provided for not feeling confident in performing CPR were related to training. Doctors at the academic hospital in this study are currently not adequately trained in CPR, which is reflected by their lack of CPR knowledge. Lack of training seems to be the most common reason for not feeling confident, and being too busy to attend these retraining courses was reported as the most common reason. It further seems that very few of the departments have CPR training for their doctors. A regular in-hospital CPR training program may improve doctor's CPR knowledge. [ABSTRACT FROM AUTHOR]

This narrative review explores current literature base detailing the effectiveness of alternative CPR instruction as compared to traditional CPR courses in the lay population. Assessment of alternative instructional methods found that video self-instruction and simplified CPR formats resulted in equivalent performance of CPR metrics and practical scenario assessment performance, as compared to traditional CPR instruction courses. While additional research is needed to further substantiate the value of self-directed learning, interactive digital, and abbreviated formats, these studies also suggested equivalence in CPR performance compared to traditional courses. In view of the importance of bystander CPR in OHCA outcomes, and the barriers presented by traditional CPR education courses, we recommend that public safety leaders and CPR educators strongly consider the introduction of these programs within their communities and classrooms. [ABSTRACT FROM AUTHOR]

Background/objective: There is still no comprehensive bibliometric study in the literature on cardiopulmonary resuscitation (CPR), an important topic in emergency medicine, the number of global studies on which is increasing day by day. In this study, it was aimed to analyze the scientific articles on CPR published between 1980 and 2020 by statistical methods and to evaluate the subject holistically.Methods: Articles on CPR published between 1980 and 2020 were downloaded from the Web of Science (WoS) database and analyzed using statistical methods. Network visualization maps were used to identify trending topics. Nonlinear regression analysis (exponential model) was used to estimate the number of articles in the coming years. Correlation studies were conducted using the Spearman correlation coefficient.Results: A total of 21,623 publications were found. Of these publications, 14,818 (68.5%) were articles. The top 3 contributing countries to the literature were the United States (5281, 35.6%), Germany (1458, 9.8%), and the United Kingdom (1152, 7.7%). The 3 most active institutions were the University of Washington (417), University of Pittsburgh (361), and University of Arizona (240). The 3 journals with the most publications were Resuscitation (2822), Critical Care Medicine (522), and the American Journal of Emergency Medicine (421).Conclusion: In this comprehensive study, a summary of 14,818 articles was presented. The trending topics in CPR research in recent years are out-of-hospital cardiac arrest, extracorporeal membrane oxygenation, cardio, simulation, in-hospital cardiac arrest, extracorporeal life support, extracorporeal cardiopulmonary resuscitation, targeted management temperature, and outcome. This article may be a useful resource on CPR global outcomes for clinicians and scientists. [ABSTRACT FROM AUTHOR]

• Simulation increased clinician support for family presence during resuscitation. • Simulation increased clinician knowledge about family presence during resuscitation. • Unclear how simulated family presence impacts technical performance of resuscitation. • Simulation can be used to evaluate outcomes of family presence during resuscitation. Family presence during resuscitation (FPDR) remains recommended, yet controversial, clinical practice. Simulation-based experiences (SBEs) may offer a strategy to address barriers to offering FPDR and to improve outcomes. This systematic review aimed to describe outcomes of SBEs related to FPDR and to provide recommendations for future work. Following PRISMA guidelines, 17 articles were evaluated for both simulation and methodologic rigor. Modalities included high-fidelity manikins, simulated participants, and case-based learning. Outcomes examined were: (a) clinician competencies, (b) practice changes, and (c) strategic resource development. Study limitations included bias due to small samples, short-term evaluation, inconsistent simulation rigor, and minimal stakeholder (family) involvement. Evidence suggests positive effects of SBEs on clinicians' knowledge and affective competencies, practice changes, and resource development. Inconsistent effects on clinicians' technical performance competencies were noted. Increased simulation rigor is needed to replicate this phenomenon. Further, increased study rigor is needed to determine long-term effects on clinician competencies and practice changes. Well-designed SBEs may be strategically used in practice, education, and research settings to address barriers to offering FPDR and to improve outcomes. [ABSTRACT FROM AUTHOR]

Aim Of the Study: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions.Methods: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded.Results: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle.Conclusion: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is the principal medical intervention used to reduce the high mortality associated with the cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric cardiopulmonary resuscitation (pCPR) amongst doctors in Cape Town. This study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary health care facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors' knowledge of equipment availability. Methods: A cross-sectional study using a questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs. Results: The questionnaire was completed by 173 doctors (84% response rate). The majority (81.8%) had not undergone pCPR training (Paediatric Advanced Life Support or Advanced Paediatric Life Support). Basic life support was done by 88.3%: 28% greater than two years ago. The average pCPR knowledge score was 61% (standard deviation [s.d.]: 20.3, range: 8.3%-100%). Doctors in their community service and internship years had significantly higher knowledge scores compared to grade 3 Medical officers (p = 0.001 and p = 0.010, respectively). Eleven per cent had performed pCPR > 10 times in the past year; 20% had never performed pCPR and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility. Conclusion: Doctors working in Cape Town PHCFs have poor knowledge, have low confidence levels and are poorly prepared to perform pCPR. Urgent attention needs to be given to ensuring formal pCPR training and acquaintance with equipment availability and location in Cape Town PHCFs. [ABSTRACT FROM AUTHOR]

• Provides a new outlook on resources and governance in sustainability transitions. • Stresses sustainability paradoxes of common-pool resources in green innovations. • Proposes new viewpoints on interaction between commons, states, and markets. • Suggests critical issues on innovation and commoning practices. Common-pool resources (CPRs) are critical in sustainability transitions. They are often important means for environmental and societal innovation, and object of unsustainable extraction and governance practices. We argue why CPRs and their governance matter in transitions and point to issues for further research: (i) conceptualization of sustainability and transitions in light of common-pool resources and governance; (ii) the roles, potentials, and challenges of commoning practices, beyond the market–state dichotomy; (iii) interactions between CPRs and commons with markets/firms and the state/governments in processes of sustainability transitions. These overarching issues bring fresh perspectives to transitions literature: (i) CPRs/commons help advance the integration between ecological and socio-technical systems (ii) non-excludable resources affect entrepreneurial activity and innovation processes in the dynamics of socio-technical system; (iii) CPRs/commons add new viewpoints to the question of directionality of transitions. We conclude by advocating for building bridges with new institutional and environmental economics, and social practice theory. [ABSTRACT FROM AUTHOR]

Introduction: The association between the level of physical activity and quality of cardio-pulmonary resuscitation (CPR) performed by laypeople is unclear. The aim of this study was to evaluate the associations between physical activity level and laypeople performance during an eight-minute scenario of CPR.Materials and Methods: This study was a secondary analysis of the MANI-CPR Trial. The entire cohort of participants was grouped based on the level of physical activity assessed using the International Physical Activity Questionnaire (IPAQ) into a "low-moderate" level group and a "high" level group. Descriptive statistics were used for unadjusted analysis and multivariate logistic and linear regression models were also performed.Results: A total of 492 participants who reached the score of "Advanced CPR performer" at the 1-min final test monitored by Laerdal Resusci Anne QCPR were included in this analysis; 224 with a low-moderate level and 268 with a high level of physical activity. A statistically significant difference was found for the outcome of percentage of compressions with adequate depth (low-moderate group: 87.8% [41·4%-99·3%], high group: 97% [63·2%-100%]; P = 0·003). No associations remained significant after controlling for biometric characteristics of the participants, compression protocols and sex.Conclusion: Adequate quality CPR may not need high baseline level of physical activity to be performed by a lay rescuer. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: We aimed to collect the available evidence on outcome regarding survival and quality of life after CPR following both IHCA and OHCA in the older population. Findings: Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Message: Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Purpose: We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population. Methods: A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL). Results: The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0–11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7–25.0% and 0–10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1–2 was found in 11.5–23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1–2 among patients surviving until hospital discharge was 82–93% (IHCA) and 77–91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies. Conclusions: Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. [ABSTRACT FROM AUTHOR]

Introduction: Mortality for out-of-hospital cardiac arrest is high when traditional chest compressions are used without adjuncts. The abdominal aortic and junctional tourniquet (AAJT) is a device with a wedge-shaped air bladder that occludes the aortic bifurcation, augmenting blood flow to the heart and brain. Previously, the addition of AAJT during chest compression led to an increase in rate of survival in a model of traumatic cardiac arrest.Hypothesis: This study was designed to determine if application of the AAJT would lead to more effective chest compressions as measured by improved hemodynamic parameters and an increased rate of return of spontaneous circulation (ROSC).Methods: Yorkshire swine (n = 6 per group) underwent general anesthesia and instrumentation. Ventricular fibrillation (Vfib) was electrically induced and animals were allocated into groups with or without the AAJT. The AAJT was inflated if selected after four minutes of compressions. Following a total of ten minutes of compressions, the animals entered into a ten-minute advanced cardiac life support phase. Hemodynamics and blood gas measurements were compared between groups.Results: ROSC or cardioversion from Vfib was not achieved in either group. The AAJT group had improved hemodynamic parameters with significantly higher carotid diastolic pressure and higher blood flow in the carotid artery (p = 0.016 and 0.028 respectively). However, no significant differences were observed with coronary perfusion pressure or end tidal CO2.Conclusion: The AAJT did not confer a survival advantage during chest compressions, but hemodynamic improvements were observed while the AAJT was in place. [ABSTRACT FROM AUTHOR]

Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome. [ABSTRACT FROM AUTHOR]

Practical relevance: Cardiopulmonary arrest (CPA) can occur in any veterinary or animal care setting and is a particular risk in scenarios involving ill, injured or anesthetized patients. Education of all staff on the prevention and recognition of CPA, as well as the performance of cardiopulmonary resuscitation (CPR), is vital to influencing outcome. Evidence base: While there is a plethora of information regarding CPA and CPR in human medicine, there are comparably few studies in the veterinary literature. Many of the current veterinary guidelines are extrapolated from human medicine or studies based on animal models. Ongoing work is needed to tailor guidelines and recommendations to our domestic feline (and canine) patients in a clinical setting. Aim: The aim of this article, which is intended for veterinarians in all areas of small animal practice, is to provide an evidence-based review of CPA and CPR in feline patients. The authors have drawn heavily on detailed recommendations published by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative – one of the few resources specific to the veterinary clinical setting – as well as reviewing the available peer-reviewed literature studies, in constructing this article. Among the topics discussed are recognizing and preventing CPA, staff training and clinic preparedness, basic life support and advanced life support interventions, and appropriate post-cardiac arrest care. [ABSTRACT FROM AUTHOR]

• Resuscitation education is imperative to prepare students for independent practice. • Virtual simulation gaming outperformed traditional presimulation preparation. • Educators should consider incorporating VSG into their simulation curriculum. Researchers at Queen's University developed a virtual simulation game to serve as a presimulation preparation tool for students learning to perform cardiac resuscitation. A pilot randomised controlled trial compared nursing students who received traditional presimulation preparation to those who received a virtual simulation game in addition to traditional presimulation preparation during a resuscitation-oriented clinical simulation. Student performance was evaluated using a 12-item performance checklist. Students provided with the virtual simulation game outperformed those provided with only the traditional presimulation preparation. Virtual simulation gaming could serve as an effective presimulation preparation tool and should be explored further. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. Objectives: To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. Methods: An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. Results: Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. Conclusions: These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth. [ABSTRACT FROM AUTHOR]

Drowning is the leading cause of childhood death in Bangladesh. In order to minimize the number of casualties Centre for Injury Prevention and Research, Bangladesh (CIPRB) incorporated a 'first responder' program which includes Cardio Pulmonary Resuscitation (CPR), in community based drowning prevention program, SwimSafe. Along with swimming lessons, swimming instructors provide first responder services in the community. The objective of this study was to describe the results of the volunteer based first responder services for the management of drowned casualties between 2012 and 2015 in the rural communities of Bangladesh. Adolescents and youths who volunteered as community swimming instructors were trained as first responders to provide first aid and resuscitation in the community. Trainers from the International Drowning Research Centre Bangladesh (IDRC-B) of CIPRB delivered the training. The first responders were also trained on the documentation of the first responder services they provided in the community. The documented records were collected from the volunteers on a regular basis; when drowning cases were reported CIPRB management followed up with an in depth data collection, using a structured form. 2,305 community volunteers were trained between 2012 and 2015. Of them 1,461 reported providing first responder services among 6,773 casualties, including 184 drowning casualties. Of the drowning casualties, volunteers treated 31 casualties with Cardiopulmonary Resuscitation (CPR), 51 casualties by putting into the recovery position and 102 casualties were treated for the shock on site. Of those given CPR, 22 (71%) survived and 9 (29%) died. After receiving treatment from the first responder 104 (56.5%) of the drowning casualties were referred to health facilities for further treatment. The training of community first responders seems to be an effective way of managing and reducing drowning causalities in countries like Bangladesh, where drowning is a significant public health hazard. [ABSTRACT FROM AUTHOR]

In-hospital cardiac arrests (IHCA) in the United States have a 21% survival-to-hospital discharge rate. This quality improvement project aimed to improve Basic Life Support–trained nursing staff responses to IHCAs at a large academic teaching hospital. Thirty-six nursing staff members were included in this pre–post design quality improvement project. A preintervention survey was administered to assess role confidence during IHCAs before implementation. A baseline 5-minute cardiac arrest simulation occurred on the nursing unit where time to interventions and quality of cardiopulmonary resuscitation data points were collected. The baseline simulation concluded with a 5-minute debrief then a repeat 5-minute cardiac arrest simulation occurred. A postintervention survey was completed to measure role confidence after implementation. The mean time to task completion significantly decreased (p <.05) for 75% of tasks. There were no statistically significant changes in the quality of chest compressions. Respondents ranked seven of nine confidence questions with a significant increase in confidence from preconfidence to postconfidence surveys (p <.05). Immediate action and resuscitation skill proficiency is essential to reduce morbidity and mortality resulting from an IHCA. In situ simulation on nursing units is an evidence-based method to maintain and reinforce resuscitation skills needed in the event of an actual patient crisis. • In situ in-hospital cardiac arrest (IHCA) simulations can improve nursing response time to task completion for an IHCA event. • Confidence responding to an IHCA improves with in situ simulation and deliberate practice. • Use of a cardiopulmonary resuscitation feedback device did not show statistically significant improvement in cardiopulmonary resuscitation skills. [ABSTRACT FROM AUTHOR]

The internet is a widely used source for obtaining medical information both by patients and physicians. YouTube is an essential source of information that may be a useful tool to inform the public and may improve the learning experience if used adequately. In this study, we aimed to estimate the quality and accuracy of videos about cardiopulmonary resuscitation videos aired on YouTube, which is the most popular video platform of the online world. We included the first 100 videos, in English, returned by the YouTube search engine in response to "cardiopulmonary resuscitation" keyword query to the study. The popularity of the videos was evaluated with an index called the video power index. The educational quality, accuracy, and transparency of the visual content were measured using the DISCERN questionnaire (DISCERN), Journal of American Medical Association (JAMA-BC) benchmark criteria, and Global Quality Score (GQS). The technical quality was measured by the Cardiopulmonary Resuscitation Scoring System (CPR-SS), which was utilized by three bariatric surgeons. The source in 7% of the videos was medical doctors. The content in 89% of the videos was cardiopulmonary resuscitation technique. According to sources, videos uploaded by physicians had significantly higher quality, transparency, educational and technical value. Unlike, videos uploaded by physicians had a lower video power index than videos uploaded by non-medical professionals. Cardiopulmonary resuscitation technique videos had significantly higher quality, transparency, educational and technical value. Cardiopulmonary resuscitation technique videos also had higher popularity scores than "information or lecture" videos. Also, negative correlations were found between the (popularity index and transparency, education and technical quality scores. Online information on cardiopulmonary resuscitation is of low quality, and its contents are of unknown source and accuracy. However, the educational potential of the online video platform, YouTube, cannot be neglected. [ABSTRACT FROM AUTHOR]

Virtual simulation gaming (VSG), also known as educationally purposeful gaming, is a new and innovative teaching method which warrants further exploration. In 2018, researchers from Queen's University in Kingston, Ontario, Canada, created an innovative VSG depicting optimal nursing care for patients in cardiac arrest secondary to ventricular fibrillation. This educational tool was created in response to global calls for increased education in the field of resuscitation science. This VSG complements a growing collection of educational games created by CAN-Sim© to best help students and experienced learners meet their educational goals. • Nurse educators can be involved in creating virtual simulation games (VSGs). • A VSG was created depicting optimal cardiac resuscitation care. • A VSG can be a positive adjunct to students' presimulation/placement preparation. [ABSTRACT FROM AUTHOR]

Purpose: Rural populations face vast disparities in out-of-hospital cardiac arrest survival rates when compared with urban populations. Furthermore, rural areas have lower CPR training rates. Compression-Only CPR (COCPR) is a simplified resuscitation method that eliminates the task of rescue breathing. The simplified nature can significantly reduce training times and be more comprehendible and convenient for the general population. The purpose of this study is to assess the change in knowledge and self-confidence of rural college students to administer COCPR as a result of mini-training sessions. Sample: Purposive sampling was used to focus on the 125 rural college students who received a COCPR mini-training session at the medium sized University located in a rural state with a historically low CPR training rate. Method: Each participant completed a 14 question pre-survey, the COCPR training, and 13 question post-survey. Descriptive statistics on the pre-, post-, and subscale change scores for both knowledge and self-confidence were computed and one-way between subjects ANOVAs were conducted to determine differences between group means related to prior CPR training. Findings: The training resulted in a positive increase in the participants' knowledge and confidence to administer care. Furthermore, the participants indicated that they would recommend this training to others. Conclusions: This study provides insight into the viability of providing COCPR in lieu of conventional CPR, supports having individuals trained at an earlier age to provide bystander care, and supports training individuals in rural areas where response time is delayed. [ABSTRACT FROM AUTHOR]

Excessive ventilatory volumes and rates during cardiopulmonary resuscitation (CPR) can lead to adverse effects, such as elevated intrathoracic pressure and decreased coronary blood flow. The 2020 American Heart Association (AHA) guidelines acknowledge the value of real-time feedback devices in improving CPR performance. In this case series, three out-of-hospital cardiac arrest cases received ventilation feedback during prehospital resuscitation and the initial in-hospital care phase. In each case, a notable increase in ventilation rate and volume was observed following the transfer of care from emergency medical services to hospital staff. This deviation from established ventilation guidelines emphasizes the importance of monitoring and addressing ventilation strategy during the transition to hospital care. Existing evidence supports the importance of maintaining specific ventilation rates and tidal volumes during cardiac arrest to improve outcomes. We believe further research is essential to establish a definitive link between ventilation strategies and patient outcomes, ultimately enhancing resuscitation efforts and patient survival rates. Integrating real-time ventilation feedback devices both in and out of the hospital during cardiac arrest presents an opportunity for quality improvement and adherence to national standards. [ABSTRACT FROM AUTHOR]

The optimization of ventilation during cardiopulmonary resuscitation (CPR) is a broad field of research. Recent physiological observations in this field challenge the current understanding of respiratory and circulatory interactions. Thanks to different models available (bench, animal, human), the understanding of physiological phenomena occurring during CPR has progressed. In this review, we describe the clinical observations that have led to the emerging concept of lung volume reduction and associated thoracic airway closure. We summarize the clinical and animal observations supporting these concepts. We then discuss the different contributions of bench, animal, and human models to the understanding of airway closure and their impact on intrathoracic pressure, airway closure, and hemodynamics generated by chest compression. The limitation of airway pressure and ventilation, resulting from airway closure reproducible in models, may play a major role in ventilation and gas exchange impairment observed during prolonged resuscitation. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) remains the key intervention following cardiac arrest because of its ability to continue circulation. Recent focus on high quality compressions during CPR has coincided with more frequent encounters of CPR Induced Consciousness (CPRIC). CPRIC represents a poorly understood patient experience during CPR and defined as signs of consciousness and pain perception during CPR.Methods: Articles were selected using PubMed, MEDLINE, CINAHL and Scopus search for the keywords "cardiopulmonary resuscitation", "consciousness", "awareness", "resuscitation", "cardio-cerebral resuscitation", "agitation" and "patient experience" yielding 336 articles. Results and their references were assessed for relevance. Articles were filtered by English language and the keyword. Case reports and case series were included. All remaining articles were reviewed and findings were discussed.Results: A total of ten articles were selected, which included data on 123 cases. Sample size varied per study from 1 to 112. Studies included cases of out-of-hospital cardiac arrest and in hospital cardiac arrest. Compressions were manually provided in most cases. Patient total recall was reported in 40% of cases. Use of sedation was reported in 40% of cases.Conclusions: There is need for continued research to better describe, explain and manage the phenomena of CPRIC. From the articles reviewed here, it is clear that further investigation has the potential to properly elucidate the patient experience including lasting psychological effects of CPRIC. Importantly, there is need for more than recognition of CPRIC from national authorities. Future research efforts should focus on establishing guidelines for the use of sedation and physical restraints, as well as the potential impact of treating CPRIC on survival. [ABSTRACT FROM AUTHOR]

Although high school coaches are encouraged to obtain certifications in cardiopulmonary resuscitation (CPR), automated external defibrillators (AED), and first aid (FA), there is no national and few state mandates for coaches to maintain adequate knowledge regarding emergency care for youth athletes. As youth participation in organized events continues to grow, the incidence of injury and sudden death has subsequently increased. The purpose of this study was to investigate high school coaches' knowledge of basic FA, CPR, and AED. Coaches (N= 89, 21.3% females, 78.2% males) at a high school coaches' association state conference completed a demographics questionnaire and 20-question, multiple-choice survey about emergency medical care. Although 87.6% of coaches who participated were FA certified and 91% were CPR certified, results of the survey indicated a lack of knowledge of basic skill-related questions in the topics of youth CPR and AED. Based on the results of the current study, coaches did not retain adequate knowledge to act competently in the event of an emergency of cardiac origin. National standards for specific emergency care education and recertification should be implemented for all high school coaches (paid or volunteer); standards that would require coaches to stay current on emergency medical interventions. [ABSTRACT FROM AUTHOR]

Background: High-quality cardiopulmonary resuscitation (CPR) is essential to survival and relies on well trained professionals. However, few studies have investigated intensive care unit nurses' CPR knowledge and attitudes relevant to intra hospital cardiac arrest. There is a dearth of tools to measure such knowledge and attitudes. Aim: To develop, validate and assess the psychometric properties of a survey related to CPR knowledge and attitudes. Method: The development and validation was based on Burns et al. (2008) method. Face and content validity, as well as reliability were respectively assessed with an expert panel (n=4), a pretest (n=9) and a testing phase (n=82). Test-retest analysis and Cronbach's alpha were used to assess reliability. Results: The NCRS contains 23 items, separated in five sections: tachydysrhythmia identification, CPR, defibrillation, attitudes and characteristics. Preliminary psychometric properties were judged as good; Cohens kappa, Spearman's correlation coefficient and Cronbach's alpha were respectively k=.814, p=.807 and a=0.645. Conclusion: The NCRS is the first survey available in French to assess knowledge and attitudes related to CPR. It will help researchers and managers to determine performance gaps regarding knowledge and attitudes towards tachydysrhythmia identification, CPR and defibrillation. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiovascular diseases are considered as the most prevalent serious disease in developed countries, and act as the number one cause of death among men and women in all ages and from all races. Aim The present research aims at determining the relationship between risk factors of cardiovascular diseases and consequences of cardiopulmonary resuscitation (CPR). Methods The present study is a retrospective analytic-cross sectional research performed on 100 patients in need for CPR (successful and unsuccessful) during March 2017 – June 2017. As research instrument, a pre-designed checklist was used including demographic information, clinical and medical information, and the information related to modifiable and non-modifiable risk factors of cardiovascular diseases. Results Obtained results indicated that, 57.1% of the successful CPR cases were administered on men, while 55.1% of unsuccessful CPR cases were administered on women. The patients diagnosed with myocardial infarction were in further need for CPR (rate of successful CPR: 66.7%, and rate of unsuccessful CPR: 61.9%). Significant associations were found between CPR duration, post-CPR survival time (survival time after CPR), systolic blood pressure, diastolic blood pressure, triglyceride level, diabetes, fasting blood sugar level, and body mass index, in one hand, and type of CPR, on the other hand (p < 0.05). Conclusion Results of the present research showed that, there is a significant relationship between modifiable risk factors of cardiovascular diseases and consequences of CPR. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest is a frequent and potentially lethal complication during a hospitalisation. Intensive care unit (ICU) nurses' knowledge, skills, and attitudes about ACLS procedures have been hypothesized to be a key determinant in patient survival. However, these three characteristics of ICU nurses, as well as their determinants, have not been studied extensively. Aim: To evaluate ICU nurses' knowledge, skills, and attitudes regarding three resuscitation procedures (i.e., identification of ventricular tachydysrhythmias, cardiopulmonary resuscitation and defibrillation), and 2) to examine the associations between ICU nurses' demographic and professional characteristics and their knowledge, skills, and attitudes about these resuscitation procedures. Method: A descriptive-correlational study, based on a cross-sectional survey, was conducted in a university hospital in Quebec (Canada) in 2017. The survey was based on the French version of the Nurses Cardiopulmonary Resuscitation Survey (NCRS), previously developed and validated by the same researchers. Survey data were analyzed descriptively, and correlations were used to identify potential determinants of ICU nurses' knowledge, skills, and attitudes regarding resuscitation procedures. Results: In total, 82 nurses completed the survey, a 40.4% response rate. Most of respondents properly identified ventricular tachydysrhythmias (89%, n=73) and 66% (n=54) had good knowledge ofCPR and defibrillation (score > 8/10). Nurses with higher NCRS scores reported being more confident in initiating manual defibrillation. ACLS-trained nurses had better chest compression knowledge. Conclusion: ICU nurses have good knowledge of CPR and defibrillation. Proper identification ofshockable and non-shockable rhythms, as well as associated interventions should be fundamental aspects of training programs. [ABSTRACT FROM AUTHOR]

Objective: Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions.Design: A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice.Methods: RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement.Results: Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device.Conclusion: We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events. [ABSTRACT FROM AUTHOR]

Background: Clinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation.Objectives: To quantify whether chest compressions with guideline-compliant depth (>2 in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest.Methods: This was a prospective, convenience sampling of adult non-traumatic out-of-hospital cardiac arrest patients receiving on-going cardiopulmonary resuscitation in an academic emergency department from June 1, 2011 to July 30, 2013. Cardiopulmonary resuscitation quality files were analyzed using R-Series defibrillator/monitors (ZOLL Medical) and ventilation data were measured using a Non-Invasive Cardiac Output monitor (Philips/Respironics, Wallingford, CT).Results: cardiopulmonary resuscitation quality data were analyzed from 21 patients (17 males, median age 59). The median compression depth was 2.2 in (IQR = 1.9, 2.5) and the median chest compression fraction was 88.4% (IQR = 82.2, 94.1). We were able to discern 580 ventilations that occurred during compressions. The median passive tidal volume recorded during compressions was 7.5 ml (IQR 3.5, 12.6). While the highest volume recorded was 45.8 ml, 81% of the measured tidal volumes were <20 ml.Conclusion: Ventilation volume measurements during emergency department cardiopulmonary resuscitation after out-of-hospital cardiac arrest suggest that chest compressions alone, even those meeting current guideline recommendations for depth, do not provide physiologically significant tidal volumes. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of death and disability, and while preferences for cardiopulmonary resuscitation (CPR) are frequently discussed, there is limited evidence detailing outcomes after CPR among acute cerebrovascular neurology (inclusive of stroke, subarachnoid hemorrhage (SAH)) patients. Systematic review and meta-analysis of PubMed and Cochrane libraries from January 1990 to December 2016 was conducted among stroke patients undergoing in-hospital CPR. Primary data from studies meeting inclusion criteria at two levels were extracted: 1) studies reporting survival to hospital discharge after CPR with cerebrovascular primary admitting diagnosis, and 2) studies reporting survival to hospital discharge after CPR with cerebrovascular comorbidity. Meta-analysis generated weighted, pooled survival estimates for each population. Of 818 articles screened, there were 176 articles (22%) that underwent full review. Three articles met primary inclusion criteria, with an estimated 8% (95% Confidence Interval (CI) 0.01, 0.14) rate of survival to hospital discharge from a pooled sample of 561 cerebrovascular patients after in-hospital CPR. Twenty articles met secondary inclusion criteria, listing a cerebrovascular comorbidity, with an estimated rate of survival to hospital discharge of 16% (95% CI 0.14, 0.19). All studies demonstrated wide variability in adherence to Utstein guidelines, and neurological outcomes were detailed in only 6 (26%) studies. Among the few studies reporting survival to hospital discharge after CPR among acute cerebrovascular patients, survival is lower than general inpatient populations. These findings synthesize the limited empirical basis for discussions about resuscitation among stroke patients, and highlight the need for more disease stratified reporting of outcomes after inpatient CPR. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although cardiac arrest during airline flights is relatively uncommon, the unusual setting, limited resources, and the variability of the skills in medical volunteers present unique challenges. Survival in patients who suffer a witnessed arrest with a shockable rhythm who are treated promptly has improved since the advent of widely available automated external defibrillators (AEDs). In general, the chances of survival from an out-of-hospital cardiac arrest (OHCA) are greater when ventricular fibrillation (VF) is seen as the initial rhythm or if there is return of spontaneous circulation (ROSC). Not all in-flight cardiac arrests are witnessed because cabin crew or fellow passengers might simply assume that the victim is sleeping. Based upon a review of the literature on resuscitation after OHCA, we recommend that automatic external defibrillators be carried on all commercial airline flights, regardless of duration. Patients presenting with shockable rhythm (e.g., VF, unstable ventricular tachycardia) have the best prognosis for survival and usually require diversion of the aircraft for advanced cardiac life support (ACLS). Because diversion may require interruption of cardiopulmonary resuscitation (CPR) and may impact flight safety, the volunteer rescuer, cabin crew, flight crew, and medical consultation services should discuss the possible outcome and operational considerations before recommending a diversion for a patient with a nonshockable rhythm. The recommendations in this article were developed by members of the Air Transport Medicine and Aerospace Human Performance Committees and approved by the Council of the Aerospace Medical Association. [ABSTRACT FROM AUTHOR]

Several parameters and variables affect the production cost and the company competitiveness. The manufacturing part cost is directly influenced by factors related to tools, workpiece materials, equipment, personnel, automation, etc. These factors also have a significant influence on the manufacturing efficiency and performance. The presented model determines the production performance with respect to the actual cost for each factor involved. The CPR relationship sets the cost of a given factor in relation to its production performance. CPR may be used to evaluate or find optimal technical solutions with respect to individual factors. [ABSTRACT FROM AUTHOR]

• The impact of TSA on team performance and outcomes has been objectively investigated and universally accepted in high reliability organizations. • The concept TSA is not well-understood in the hospital emergency context. • Healthcare team functions are dynamic and complex requiring human control and with small margins for error. Successful management of in-hospital life threatening and emergency conditions require a well working, collaborative team. One of the vital skills that enhance team coordination of information and actions is team situational awareness (TSA). Although the concept of TSA has been long known in military and aviation settings, the concept has not been well investigated in the hospital emergency context. This analysis was to explore the concept of "TSA" in the context of hospital emergency to explain its meaning for optimum understanding and use in clinical practice and future research. TSA encompasses two types of situational awareness, each equally important: complementary (individual) and shared situational awareness (SA). The three defining attributes of complementary SA are the perception, comprehension, and projection, meanwhile, the three defining attributes of shared SA include: (1) information is clearly shared; (2) interpreted in the same way; and (3) the same projection of actions formed to guide expectation. Although, TSA is related to other terms in literature, there is increasing acknowledgment that the concept has an impact on team performance. Finally, the two types of TSA should be considered when assessing team performance TSA is acknowledged in different fields requiring human control as a significant construct for team performance. Yet it needs to be examined in the emergency hospital context, systematically investigated and agreeably recognized as a fundamental factor in team performance. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question “What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?” We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training. [ABSTRACT FROM AUTHOR]

Lesvos is a Greek island that during 2015 experienced the largest refugee crisis the country has ever witnessed. Refugees arriving to the island in groups totalling over 1.000.000 passed through the island. The current project using a UAV sought to identify the routes of refugees passing through tourism areas of the island and the possible impact these routes had on the development of these areas. Furthermore, the preservation of the common pool resources of these areas is a vital issue for the well being of local communities and the enchancement of their spirit of welcoming the refugees. An automated system used to inform local authorities about areas polluted by the mass movement of people is presented in this paper. [ABSTRACT FROM AUTHOR]

Abstract Background The investigations of predictors of success or failure of cardiac resynchronization therapy were studied previously. Assessment of success in patients already on dual or single pacemakers and upgraded to cardiac resynchronization therapy (CRT) were not extensively studied before. How to select patients in whom this may be the most optimal strategy is unclear. We sought to determine factors associated with success or failure in this group of patients who were already paced for heart block. Methods 81 pts were subjected to upgrade to CRT implantation after being on pacemaker. The study was conducted in Germany. Data was presented as Median (Min.–Max.) for abnormally distributed data or Mean ± SD. for normally distributed data. Parameters that revealed no statistical significance in response: Age, sex, EF, diabetes, renal disease, GFR, MR, QRS duration (all above 150 ms), history of ablation, AF recurrence, previous pacemaker, optimization. The following parameters revealed significant influence on response to CRT: Less responders with: Higher C reactive protein (CRP), presence of tricuspid incompetence (TR), presence of pulmonary hypertension (PHN), presence of previous MI, being ischemic vs nonischemic cardiomyopathy (CM) (less responders with ischemic CM). Conclusions The findings through light on specific parameters that predict response to upgrade to CRT after usual pacemaker. [ABSTRACT FROM AUTHOR]