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Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]

Background: There has been an explosive growth of ECPR within new and established ECMO programs worldwide with the concomitant need for simulation trainers. However, current commercially available ECMO simulation models are expensive and lack many standard cardiorespiratory resuscitative (CPR) features.Objective: To use 3-dimensional (3D) printing to develop a training manikin for comprehensive ECPR simulation.Methods: A standard commercially available CPR manikin with airway model was used as the base model for modification. An inexpensive 3D printer was used to print a modular plastic pelvis. A medical silicone gel incorporated silicone femoral vasculature component was manufactured with connection to a gravity fed vascular system.Results: The resulting modified manikin included the modular in-house designed ECMO cannulation and vascular structures wedded to the commercially available airway and CPR components. In simulation exercise involving first responders, paramedics, and emergency and critical care physicians, the model was reported as realistic with ultrasound views, cannulation, and resuscitative components functional. The entire cost for development of the ECMO component was estimated at $2000 Australian dollars AUD, including the printer purchase and supplies. Future reuse of components is estimated to cost less than $5 AUD per simulation run.Conclusions: A novel in-house modified manikin for ECPR was developed that was cost-efficient and realistic to use from first response through to establishment of ECMO circulation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of the addition of information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes on staff confidence to respond to emergency scenarios with these populations., Materials and Methods: A pre-test post-test intervention study was conducted with staff from one of the largest disability organisations in Tasmania, Australia. Supplemented CPR and BLS classes were presented to participants. A purpose-designed questionnaire was completed pre, post, and six-months post after the training., Results: A significant rise in confidence post-training was demonstrated, and this was retained at the six-month time point. Time spent in the disability sector before the supplemented training or attendance at previous standard CPR classes did not have a significant effect on confidence levels before the supplemented training., Conclusions: Confidence is closely linked to willingness to act during emergency situations. Improved confidence may therefore result in improved willingness to act for people with disability, atypical chest shapes, and wheelchair users, thus improving health outcomes for these populations and providing this cohort with access to more equitable healthcare.IMPLICATIONS FOR REHABILITATIONGuidelines for undertaking CPR and BLS on people with atypical chest shapes and/or in a wheelchair are not currently available.Including information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes increases staff confidence to respond to such situations.Supplementary disability-specific information can be successfully incorporated into existing CPR and BLS training.

Abstract: Background: Controversy exists around CPR in the elderly. The characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in this age group were studied in Melbourne, Australia. Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for all OHCAs not witnessed by Emergency Medical Services (EMS) occurring in those aged 65 years and older. Results: Between 2000 and 2009 there were 30,006 OHCAs of which 9703 (32%) were in people 65–79 years of age, 6430 (21%) in octogenarians, 1530 (5%) in nonagenarian and 40 (0.1%) in centenarians. Rates of attempted resuscitation decreased with advancing age: 48% for those aged 65–79 years, 39% for octogenarians, 31% for nonagenarians and 17% for centenarians. Similarly rates of survival to hospital discharge decreased with age: 8% for those aged 65–79 years, 4% for octogenarians, 2% for nonagenarians; for 65–79 year olds, octogenarians and nonagenarians survival if in VF/VT was – 17%, 10% and 4%; asystole – 1%, 1% and 0.5%; and PEA – 6%, 3% and 3%, respectively. Multivariable logistic regression shows that between 2000 and 2009 rates of transportation with return of spontaneous circulation have improved for both shockable and non-shockable rhythms [OR 95% CI 1.07(1.04–1.10) and 1.16(1.12–1.20), respectively] but survival to hospital discharge has improved in the shockable rhythm group only [OR 1.12(1.07–1.16)]. Conclusion: Outcomes for OHCA with shockable rhythm have improved over the last 10 years for people aged 65 years and over. Quality of life studies should be performed to help inform the community and EMS on appropriate resuscitative efforts. [Copyright &y& Elsevier]

In keeping with the pre-eminent status accorded autonomy within Australia, Europe, and the United States, medical practice requires that patients authorize do-not-resuscitate (DNR) orders, intended to countermand the default practice in hospitals of instituting cardiopulmonary-resuscitation (CPR) on all patients experiencing cardio-pulmonary arrest. As patients typically do not make these decisions proactively, however, family members are often asked to act as surrogate decision-makers and decide on the patient's behalf. Although the appropriateness of patients or their families having to decide about the provision of CPR has been challenged, there has been little examination of how patients and their families talk about and negotiate such decisions, particularly in the context of the patient's imminent death. In this article, part of a larger study analysing interviews with 28 patients (13 female) with cancer within weeks of their death, and 20 others (predominantly family) attending, we argue that a common assumption underpinning participants' talk about the DNR decision (i.e. forgoing CPR) is that it requires a choice between life and death. Using illustrative examples, we demonstrate that in making decisions about CPR, patients and their families are implicitly required to make moral judgements about the value of the patient's life, including their relationships with significant others. We identify some implications of these empirical observations for the development of ethically appropriate policies and practices regarding patient autonomy and surrogacy at the end of life. [ABSTRACT FROM AUTHOR]

A key objective of an emergency call for cardiac arrest is to recruit a bystander to perform cardio-pulmonary resuscitation (CPR) until the ambulance arrives. Emergency medical services worldwide work towards increasing the rate of bystander-CPR, and existing research has identified a number of physical barriers to the provision of bystander-CPR. Yet, little is known about the specific ways in which emergency callers resist recruitment to perform basic first-aid, sometimes in the absence of any physical obstacle. This study investigated 65 emergency calls for cardiac arrest received in Australia in 2014 and 2015, in which the callers initially resisted CPR. We used conversation analysis to examine callers' practices to resist recruitment and call-takers' practices to counter this resistance. We found that callers who resisted CPR typically provided an account. When callers accounted for their resistance on deontic grounds, they expressed that CPR was not a possible course of action (e.g. "I can't do it"). When callers provided an epistemic account, their justification was based on their knowledge or opinion (e.g. "I think it's too late"). Our findings suggest that epistemic resistance can be a barrier to bystander-CPR. We identified two practices used by call-takers to address caller resistance based on epistemics. Providing more context on the purpose of CPR (e.g. "this is to help him in the meantime") seemed effective in persuading callers to perform CPR. By contrast, aligning with the caller's epistemic and deontic rights (e.g. "it's up to you") did not seem effective in persuading callers. • Emergency callers account for their resistance to provide first aid to patients. • Saying that the patient is already dead is a common justification for resisting CPR. • Callers can be persuaded when provided with more context on CPR. • Conversation Analysis can identify strategies to overcome barriers to CPR. [ABSTRACT FROM AUTHOR]