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Background: Simulation-based medical education has been used in medical training for decades. Rapid cycle deliberate practice (RCDP) is a novel simulation strategy that uses iterative practice and feedback to achieve skill mastery. To date, there has been minimal evaluation of RCDP vs standard immersive simulation (IS) for the teaching of cardiopulmonary resuscitation to graduate medical education (GME) learners. Our primary objective was to compare the time to performance of Advanced Cardiac Life Support (ACLS) actions between trainees who completed RCDP vs IS.Methods: This study was a prospective, randomized, controlled curriculum evaluation. A total of 55 postgraduate year-1 internal medicine and emergency medicine residents participated in the study. Residents were randomized to instruction by RCDP (28) or IS (27). Stress and ability were self-assessed before and after training using an anonymous survey that incorporated five-point Likert-type questions. We measured and compared times to initiate critical ACLS actions between the two groups during a subsequent IS.Results: Prior learner experience between RCDP and IS groups was similar. Times to completion of the first pulse check, chest compression initiation, backboard placement, pad placement, initial rhythm analysis, first defibrillation, epinephrine administration, and antiarrhythmic administration were similar between RCDP and IS groups. However, RCDP groups took less time to complete the pulse check between compression cycles (6.2 vs 14.2 seconds, P = 0.01). Following training, learners in the RCDP and IS groups scored their ability to lead and their levels of anticipated stress similarly (3.43 vs 3.30,(P = 0.77), 2.43 vs. 2.41, P = 0.98, respectively). However, RCDP groups rated their ability to participate in resuscitation more highly (4.50 vs 3.96, P = 0.01). The RCDP groups also reported their realized stress of participating in the event as lower than that of the IS groups (2.36 vs 2.85, P = 0.01).Conclusion: Rapid cycle deliberate practice learners demonstrated a shorter pulse check duration, reported lower stress levels associated with their experience, and rated their ability to participate in ACLS care more highly than their IS-trained peers. Our results support further investigation of RCDP in other simulation settings.

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study explored the cardiac emergency preparedness of school employees in Illinois, as well as their attitudes toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training.One thousand two hundred seventy‐six school employees completed an online survey regarding their school's cardiac emergency preparedness, as well as their access to CPR/AED training, confidence and willingness to perform CPR/AED, and attitudes toward CPR policies and mandates.In total, results from 1273 school employees were analyzed. School employees in Illinois are not prepared to respond to a cardiac emergency, but desire training, plans, and drills. Demographic analyses revealed statistically significant differences in cardiac emergency preparedness between individuals of different personal and school characteristics.School employees in Illinois are not prepared to respond to a cardiac emergency. To increase preparedness for cardiac emergencies at school, schools should implement CPR/AED training for all employees, cardiac emergency response plans, and cardiac emergency response drills.Policies should be implemented at the state and local level to support cardiac emergency preparedness in schools, including mandated CPR/AED training for all school employees, cardiac emergency response plans for every building, and required cardiac emergency response drills. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to evaluate the feasibility and quality of chest compressions (CCs) performed by police officers on a victim wearing a bulletproof vest as well as analyze the time taken to remove the vest. Methods: Ten officers conducted two 5‐min cardiopulmonary resuscitation (CPR) trials. Trial 1: on a dummy wearing bulletproof vest (CPR‐VEST)/Trial 2: bare‐torso dummy (CPR‐NO). Results: CC's quality and the timed vest removal. Results show that CC's quality was a median of 90% in CPR‐VEST and 99% in CPR‐NO (p = 0.08). There were significantly poorer results in CPR‐VEST in CC with correct recoil (CPR‐VEST: 12%, CPR‐NO: 10%, and p = 0.04) and rate (CPR‐VEST: 82%, CPR‐NO: 97%, and p = 0.01). The bulletproof vest removal time was 9.45 ± 1.33 s. Conclusion: The removal of the vest is prioritized to facilitate CPR. CC over the vest is performed with similar quality levels to standard CPR, supporting the immediate initiation of CPR in special circumstances where the vest cannot be removed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic accuracy of carotid artery compression using a point-of-care ultrasound probe (POCUS-CAC) in reducing pulse check times and facilitating the detection of the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) compared to manual palpation (MP). The secondary aim of the study is to assess the ability of POCUS-CAC to detect ROSC during ongoing chest compressions. Methods: This prospective study was conducted in a tertiary emergency department between January and June 2023. During CPR, POCUS-CAC was performed by placing a linear ultrasound probe transversely on the lateral neck to assess the compressibility of the carotid artery. Complete compression of the artery without any visible pulsation indicated no ROSC, while resistance to compression or partial compression suggested the presence of ROSC. Simultaneously, another clinician performed manual palpation of the femoral artery. The primary outcome assessed in this study was comparing ROSC detection between POCUS-CAC and traditional methods, and the secondary outcome was comparing the time taken to detect ROSC with each method, and the ability to detect ROSC during ongoing chest compressions. Results: The study included 41 cardiac arrest patients and analyzed 496 MP pulse and 1984 POCUS-CAC checks. The mean time to identify a pulse using POCUS-CAC was significantly shorter, at 2.3 (0.5–7.8, SD ± 1.2, 95% CI [2.25, 2.35]) s, compared to 4.7 (2.0–10.5, SD ± 1.8, 95% CI [4.54, 4.86]) s with MP (p = 0.004). Additionally, 52.9% of ROSC cases were detected earlier using POCUS-CAC, even during ongoing chest compressions. The sensitivity of POCUS-CAC was 100% (95% CI [80.5–100%]) and the specificity was 87.5% (95% CI [67.6–97.3%]). The POCUS-CAC method required less than 5 s in 99.996% of cases. Conclusions: POCUS-CAC significantly reduces pulse check times and enhances the early detection of ROSC during CPR, offering a reliable and rapid alternative to traditional manual palpation methods in emergency settings. [ABSTRACT FROM AUTHOR]

Introduction: By using a novel survey our study aimed to assess the challenges ECMO and Critical Care (CC) teams face when initiating and managing patient's ECMO support. Methods: A qualitative survey-based observational study was performed of members of 2 Critical Care Medicine organizations involved in decision-making around the practice of Extracorporeal Membrane Oxygenation (ECMO). The range of exploratory questions covered ethical principles of informed consent, autonomy and goals of care discussions, beneficence, non-maleficence (offering life-sustaining treatments in end-of-life care), and justice (insurance-related limitations of treatment). Questions also covered pragmatic practice and quality improvement areas, such as exploring whether palliative care or ethics teams were involved in such decision-making. Results: 305 members received the survey links, and a total of 61 completed surveys were received, for an overall response rate of 20% among all eligible members. Only 70% of the participants who manage ECMO patients are involved in the ECMO initiation decision process. The majority do not involve Ethics or Palliative care at the initial ECMO initiation decision step. Of the ethical and moral dilemmas reported, the majority revolved around 1. Prognostication of patients receiving VV and VA ECMO support, 2. Lack of knowledge of patient's wishes and goals, 3. Disconnect between expectations of families and outcomes and 4. Staff moral distress around when to stop ECMO in case of futility. Conclusion: Our survey highlights areas of distress and dilemma which have been stressed before in the initiation, management, and outcomes of ECMO patients, however with the increasing use of this modality of cardiopulmonary mechanical support being offered, the survey results can offer a guidance using sound ethical principles. [ABSTRACT FROM AUTHOR]

Background: Management of in-hospital cardiac arrest includes many component skills that require considerable training in order to gain mastery. Practicing defibrillation skills in a simulated setting improves performance and time to shock delivery but is cumbersome and costly. Virtual reality (VR) simulation training may provide an alternative platform to help medical students learn and build confidence in the critical steps required to operate a manual defibrillator. Intervention: We performed a pilot study to implement a VR simulation that trains learners on the stepwise operation of a manual defibrillator. Methods: We conducted a cross-sectional survey that measured the feasibility, usability, and likeability of a VR simulation among fourth-year medical students at a large urban academic medical center. Secondary outcomes included self-efficacy with operating a defibrillator before and after the VR simulation, and time to defibrillation within the simulation. Results: Twenty-six participants completed the VR simulation. The majority of participants found the VR simulation easy to use (71% agreed), liked the experience (96% agreed), found it realistic (87.5% agreed), and would recommend it to their peers (96% agreed). Most students (96%) agreed that the training improved their knowledge of how to use a defibrillator, and all (100%) students agreed that they were more confident than beforehand in using the defibrillator to defibrillate a patient with cardiac arrest. Self-reported knowledge and comfort with using the defibrillator significantly improved from before to after the VR training, as did average time to defibrillation. Discussion: VR simulation for defibrillator training is feasible and well-liked by senior medical students and is associated with improved self-perceived knowledge and comfort with using a manual defibrillator. [ABSTRACT FROM AUTHOR]

Background: High-quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view of the existing evidence on the effectiveness of CPR methods. Methods: PubMed, EMBASE, and Medline were searched, including English in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) SRs, and comparing mechanical versus manual CPR. A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) and GRADE were used to assess the quality of included SRs/studies. We included both IHCA and OHCA, which compared mechanical and manual CPR. We analyzed at least one of the outcomes of interest, including ROSC, survival to hospital admission, survival to hospital discharge, 30-day survival, and survival to hospital discharge with good neurological function. Furthermore, subgroup analyses were performed for age, gender, initial rhythm, arrest location, and type of CPR devices. Results: We identified 249 potentially relevant records, of which 238 were excluded. Eleven SRs were analyzed in the Umbrella review (January 2014–March 2022). Furthermore, for a new, additional SR, we identified eight eligible studies (not included in any prior SR) for an in-depth analysis between April 1, 2021, and February 15, 2024. The higher chances of using mechanical CPR for male patients were significantly observed in three studies. Two studies showed that younger patients received more mechanical treatment than older patients. However, studies did not comment on the outcomes based on the patient's gender or age. Most SRs and studies were of low to moderate quality. The pooled findings did not show the superiority of mechanical compared to manual CPR except in a few selected subgroups. Conclusions: Given the significant heterogeneity and methodological limitations of the included studies and SRs, our findings do not provide definitive evidence to support the superiority of mechanical CPR over manual CPR. However, mechanical CPR can serve better where high-quality manual CPR cannot be performed in selected situations. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest (CA) is a life-critical condition. Patients who survive after CA go into a defined post-cardiac arrest syndrome (PCAS). In this clinical context, the role of the echocardiogram in recent years has become increasingly important to assess the causes of arrest, the prognosis, and any direct and indirect complications dependent on cardiopulmonary resuscitation (CPR) maneu-vers. Methods: We have conduct a narrative revision of literature. Results: The aim of our review is to evaluate the increasingly important role of the transthoracic and transesophageal echocardiogram in the CA phase and especially post-arrest, analyzing the data already present in the literature. Conclusion: Transthoracic and transesophageal echocardiogram in the CA phase take on important diagnostic and prognostic role. [ABSTRACT FROM AUTHOR]

This report describes a 34‐year‐old male admitted to the medical intensive care unit (ICU) who sustained cardiac arrest while in prone positioning. Prone position CPR was initiated, and the utilization of point‐of‐care ultrasound (POCUS) during CPR was necessary to assess compression quality. Specifically, the popliteal was observed using POCUS to gauge the adequacy of compressions and subsequent perfusion during prone position CPR. This approach provides insight into assessing the effectiveness of chest compressions in a challenging prone position, potentially improving outcomes in similar cases. Further research and application of POCUS in this context may enhance the quality of CPR and patient care during cardiac arrest events in prone positioning. [ABSTRACT FROM AUTHOR]

Introduction and objective: Sudden cardiac arrest (SCA) is a significant cause of adult mortality, categorized into in-hospital (IHCA) and out-of-hospital (OHCA). Survival in OHCA depends on early diagnosis, alerting Emergency Medical Service (EMS), high-quality bystander resuscitation, and prompt Automatic External Defibrillator (AED) use. Accelerating technological progress supports faster AED retrieval and use, but there are barriers in real-life OHCA situations. The study assesses 6th-year medical students' ability to locate AEDs using smartphones, revealing challenges and proposing solutions. Material & Methods: The study was conducted in 2022–2023 at the Medical University of Lodz, Poland. Respondents completed a survey on AED knowledge and characteristics, followed by a task to find the nearest AED using their own smartphones. As common sources did not list the University AEDs, respondents were instructed to locate the nearest AED outside the research site. Results: A total of 300 6th-year medical students took part in the study. Only 3.3% had an AED locating app. Only 32% of students claimed to know where the AED nearest to their home is. All 300 had received AED training, and almost half had been witness to a resuscitation. Out of the 291 medical students who completed the AED location task, the median time to locate the nearest AED was 58 s. Most participants (86.6%) found the AED within 100 s, and over half (53%) did so in under 1 min. Conclusions: National registration of AEDs should be mandatory. A unified source of all AEDs mapped should be created or added to existing ones. With a median of under one minute, searching for AED by a bystander should be considered as a point in the chain of survival. [ABSTRACT FROM AUTHOR]

(1) Objective: This study aimed to assess the evolution of the quality of ventilations of a group of rescuers after two training sessions by taking into account inspiration times. (2) Materials and Methods: A pilot simulation study was carried out with a sample of 10 lifeguard students. Two training sessions were held three weeks apart, in which CPR skills were trained by means of feedback tools. Participants performed three tests in pairs on a ResusciAnne QCPR® manikin connected to SkillReporter QCPR software, namely one pre-training test and one test after each training session. CPR was performed in pairs for two minutes and began with five rescue breaths. (3) Results: One training session was enough to improve chest compression quality (T0: 48%; IQR 17–77/T1: 83%; IQR 59–88; p = 0.022/T2: 79%; IQR 64–92; p = 0.002). The quality of the ventilations increased progressively in each training session without reaching high-quality results (T0: 0%; IQR 0–0/T2: 15%; IQR 8–27; p = 0.011). (4) Conclusion: A two-session training program focused on inspiratory times achieved significant improvements in the quality of bag-mask ventilations performed by lifeguard students. Training focused on the insufflation time of ventilations and not only on the volume seems to be an important factor in improving the quality of ventilations. [ABSTRACT FROM AUTHOR]

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Abstract Air traveler numbers are predicted to reach 4.0 billion in 2024. Between 1/15,000–50,000 passengers will experience acute medical problems inflight with cardiac arrests requiring cardiopulmonary resuscitation (CPR) accounting for 0.3% of medical emergencies. Hypoxia in airplane cabins could impair oxygenation and physical performance of caregivers. We conducted a randomized controlled, double-blind study to test the hypothesis that hypoxia decreases the effectiveness in performing CPR. We randomized 24 healthcare professionals to two different study arms, each consisting of two conditions: arm (1) ‘hypoxia (FiO2 15%, equivalent to 2400 m altitude)’ versus ‘normoxia’; arm (2) ‘hypoxia + supplemental oxygen’ versus ‘normoxia + supplemental oxygen’. The order of conditions was counterbalanced and a minimum wash-out period of 24 h was granted between conditions. In each condition participants performed a 5-min cardiac compression only CPR (CCO-CPR) using a full-body manikin after one, three and six hours in an altitude chamber. Mixed ANOVAs with post-hoc false-discovery-rate adjusted pairwise comparisons indicated that although compression frequency was maintained, the number of compressions with correct depth was decreased at all times during hypoxia compared to normoxia (all p

Abstract Introduction The aim was to evaluate the feasibility and quality of chest compressions (CCs) performed by police officers on a victim wearing a bulletproof vest as well as analyze the time taken to remove the vest. Methods Ten officers conducted two 5‐min cardiopulmonary resuscitation (CPR) trials. Trial 1: on a dummy wearing bulletproof vest (CPR‐VEST)/Trial 2: bare‐torso dummy (CPR‐NO). Results CC's quality and the timed vest removal. Results show that CC's quality was a median of 90% in CPR‐VEST and 99% in CPR‐NO (p = 0.08). There were significantly poorer results in CPR‐VEST in CC with correct recoil (CPR‐VEST: 12%, CPR‐NO: 10%, and p = 0.04) and rate (CPR‐VEST: 82%, CPR‐NO: 97%, and p = 0.01). The bulletproof vest removal time was 9.45 ± 1.33 s. Conclusion The removal of the vest is prioritized to facilitate CPR. CC over the vest is performed with similar quality levels to standard CPR, supporting the immediate initiation of CPR in special circumstances where the vest cannot be removed.

Abstract Introduction and objective Sudden cardiac arrest (SCA) is a significant cause of adult mortality, categorized into in-hospital (IHCA) and out-of-hospital (OHCA). Survival in OHCA depends on early diagnosis, alerting Emergency Medical Service (EMS), high-quality bystander resuscitation, and prompt Automatic External Defibrillator (AED) use. Accelerating technological progress supports faster AED retrieval and use, but there are barriers in real-life OHCA situations. The study assesses 6th-year medical students’ ability to locate AEDs using smartphones, revealing challenges and proposing solutions. Material & Methods The study was conducted in 2022–2023 at the Medical University of Lodz, Poland. Respondents completed a survey on AED knowledge and characteristics, followed by a task to find the nearest AED using their own smartphones. As common sources did not list the University AEDs, respondents were instructed to locate the nearest AED outside the research site. Results A total of 300 6th-year medical students took part in the study. Only 3.3% had an AED locating app. Only 32% of students claimed to know where the AED nearest to their home is. All 300 had received AED training, and almost half had been witness to a resuscitation. Out of the 291 medical students who completed the AED location task, the median time to locate the nearest AED was 58 s. Most participants (86.6%) found the AED within 100 s, and over half (53%) did so in under 1 min. Conclusions National registration of AEDs should be mandatory. A unified source of all AEDs mapped should be created or added to existing ones. With a median of under one minute, searching for AED by a bystander should be considered as a point in the chain of survival.

Injury and illness can occur in children. Since children spend a considerable amount of time in school, teachers must have the ability to assist when required. However, no research to date has examined Irish primary school teachers' experiences, training and knowledge in first aid. An online survey (n = 587) examined Irish male and female primary school teachers previous first aid experiences, training and knowledge. Respondents generally showed high levels of both previous first aid training and exposure to events requiring first aid. In addition, most teachers knew the location of the school's first aid equipment and were aware of their school's first aid policy. However, many felt ill-equipped to deal with these situations, particularly for serious incidents and over a third of teachers were not currently certified in first aid. While teachers displayed good overall knowledge, gaps were evident. The findings demonstrate the need to develop a multilevel school strategy to ensure teacher proficiency and school preparedness in managing situations requiring first aid. [ABSTRACT FROM AUTHOR]

Abstract Introduction Cardiopulmonary resuscitation (CPR) is frequently performed in hospitalized patients after in-hospital cardiac arrest (IHCA), especially in the intensive care unit (ICU) (J Crit Care 24:408-414, 2009). Despite the fact that nearly half of the in-hospital cardiac arrests (IHCA) actually happen in intensive care units (ICUs) (N Engl J Med 367:1912-1920, 2012), intensive care unit cardiac arrest (ICU-CA) compared to IHCA or out-of-hospital cardiac arrests (OHCA) has received little attention, and data on ICU-CA remains scanty (Intensive Care Med 40:1853-1916, 2014). Aim We aimed to evaluate the clinical status and factors associated with the survival of patients subjected to cardiopulmonary resuscitation (CPR) after a witnessed cardiac arrest (CA) inside the medical intensive care unit (MICU). Patients The study included 110 patients, mean age of 60 ± 18 years, 69 (63%) males, and 41 (37%) females. Co-morbidities included diabetes mellitus was present in 46 (42%), hypertension 57 (52%), central nervous system (CNS) disease 31 (29%), cardiovascular (CVS) 76 (69%), respiratory 63 (57%), hepatic 16 (15%), shock 35 (32%), and renal 44 (40%). Mechanical ventilation was present in 97 (88%) of patients. SOFA score 7 in 66% of patients. Non-shockable rhythm occurred in 95 (86%) while shockable rhythm in 15 (14%) of patients. Methods Data were collected prospectively at the medical ICU of Cairo University from Jan. 2013 to Feb 2013. A resuscitation protocol was done according to the latest recommendation of the European Society of Cardiology at the time of patient inclusion. Clinical data were recorded and surviving patients were clinically followed daily until hospital discharge. Results Out of 110 witnessed cardiac arrests, CPR was initially successfully manifested by return of spontaneous circulation (ROSC) in 60 patients (55%), of whom 22 (20%) survived hospital discharge and only 9 patients (8%) were functionally independent. Compared to non-survivors, 60 patients (55%) with ROSC had a MPM III 9 (p 0.001), MPM III > 10 (0.018), and time to start CPR > 1 min (p 0.001). Conclusion Not all ROSC reached long-term survival and hospital discharge. Several co-morbidities affect ROSC and short-term and long-term patient survival after witnessed MICU cardiac arrest.

Abstract Background To better understand the influence of habitat on the genetic content of bacteria, with a focus on members of Candidate Phyla Radiation (CPR) bacteria, we studied the effects of transitioning from soil via seepage waters to groundwater on genomic composition of ultra-small Parcubacteria, the dominating CPR class in seepage waters, using genome resolved metagenomics. Results Bacterial metagenome-assembled genomes (MAGs), (318 total, 32 of Parcubacteria) were generated from seepage waters and compared directly to groundwater counterparts. The estimated average genome sizes of members of major phyla Proteobacteria, Bacteroidota and Cand. Patescibacteria (Candidate Phyla Radiation – CPR bacteria) were significantly higher in soil-seepage water as compared to their groundwater counterparts. Seepage water Parcubacteria (Paceibacteria) exhibited 1.18-fold greater mean genome size and 2-fold lower mean proportion of pseudogenes than those in groundwater. Bacteroidota and Proteobacteria also showed a similar trend of reduced genomes in groundwater compared to seepage. While exploring gene loss and adaptive gains in closely related CPR lineages in groundwater, we identified a membrane protein, and a lipoglycopeptide resistance gene unique to a seepage Parcubacterium genome. A nitrite reductase gene was also identified and was unique to the groundwater Parcubacteria genomes, likely acquired from other planktonic microbes via horizontal gene transfer. Conclusions Overall, our data suggest that bacteria in seepage waters, including ultra-small Parcubacteria, have significantly larger genomes and higher metabolic enrichment than their groundwater counterparts, highlighting possible genome streamlining of the latter in response to habitat selection in an oligotrophic environment.

There is insufficient evidence supporting the theory that mechanical ventilation can replace the manual ventilation method during CPR. Is using automatic mechanical ventilation (MV) feasible and comparable to the manual ventilation method during CPR? This pilot randomized controlled trial compared MV and manual bag ventilation (BV) during CPR after out-of-hospital cardiac arrest (OHCA). Patients with medical OHCA arriving at the ED were randomly assigned to two groups: an MV group using a mechanical ventilator and a BV group using a bag valve mask. Primary outcome was any return of spontaneous circulation (ROSC). Secondary outcomes were changes of arterial blood gas analysis results during CPR. Tidal volume, minute volume, and peak airway pressure were also analyzed. A total of 60 patients were enrolled, and 30 patients were randomly assigned to each group. There were no statistically significant differences in basic characteristics of OHCA patients between the two groups. The rate of any return of spontaneous circulation was 56.7% in the MV group and 43.3% in the BV group, indicating no significant (P =.439) difference between the two groups. There were also no statistically significant differences in changes of PH, P co 2 , P o 2 , bicarbonate, or lactate levels during CPR between the two groups (P values =.798, 0.249,.515,.876, and.878, respectively). Significantly lower tidal volume (P <.001) and minute volume (P =.009) were observed in the MV group. In this pilot trial, the use of MV instead of BV during CPR was feasible and could serve as a viable alternative. A multicenter randomized controlled trial is needed to create sufficient evidence for ventilation guidelines during CPR. ClinicalTrials.gov ; No.: NCT05550454; URL: www.clinicaltrials.gov. [Display omitted] [ABSTRACT FROM AUTHOR]

The versatility of cytochrome P450 reductase (CPR) in transferring electrons to P450s from other closely related species has been extensively exploited, e.g., by using An. gambiae CPR (AgCPR), as a homologous surrogate, to validate the role of An. funestus P450s in insecticide resistance. However, genomic variation between the AgCPR and An. funestus CPR (AfCPR) suggests that the full metabolism spectrum of An. funestus P450s might be missed when using AgCPR. To test this hypothesis, we expressed AgCPR and AfCPR side-by-side with CYP6P9a and CYP6P9b and functionally validated their role in the detoxification of insecticides from five different classes. Major variations were observed within the FAD- and NADP-binding domains of AgCPR and AfCPR, e.g., the coordinates of the second FAD stacking residue AfCPR-Y456 differ from that of AgCPR-His456. While no significant differences were observed in the cytochrome c reductase activities, when co-expressed with their endogenous AfCPR, the P450s significantly metabolized higher amounts of permethrin and deltamethrin, with CYP6P9b-AfCPR membrane metabolizing α-cypermethrin as well. Only the CYP6P9a-AfCPR membrane significantly metabolized DDT (producing dicofol), bendiocarb, clothianidin, and chlorfenapyr (bioactivation into tralopyril). This demonstrates the broad substrate specificity of An. funestus CYP6P9a/-b, capturing their role in conferring cross-resistance towards unrelated insecticide classes, which can complicate resistance management. [ABSTRACT FROM AUTHOR]

Background: Basic life support (BLS) is a life-saving link in the out-of-hospital cardiac arrest chain of survival. Most members of the public are capable of providing BLS but are more likely to do so confidently and effectively if they undertake BLS training. Lay members of the public comprise diverse and specific populations and may benefit from tailored BLS training. Data on this topic are scarce, and it is completely unknown if there are any benefits arising from tailored courses or for whom course adaptations should be developed. Methods: The primary objective of this scoping review was to identify and describe differences in patient, clinical, and educational outcomes when comparing tailored versus standard BLS courses for specific layperson populations. This review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. Results: A primary search identified 1307 studies and after title, abstract, and full-text screening, we included eight publications reporting on tailored courses for specific populations. There were no studies reporting direct comparisons between tailored and standardized training. Seven (88%) studies investigated courses tailored for individuals with a disability, and only one study covered another specific population group (refugees). Overall, the quality of evidence was low as the studies did not compare tailored vs. non-tailored approaches or consisted of observational or pre–post-designed investigations. Conclusions: Tailored BLS education for specific populations is likely feasible and can include such groups into the pool of potential bystander resuscitation providers. Research into comparing tailored vs. standard courses, their cost-to-benefit ratio, how to best adapt courses, and how to involve members of the respective communities should be conducted. Additionally, tailored courses for first responders with and without a duty to respond could be explored. [ABSTRACT FROM AUTHOR]

Background: Decisions regarding resuscitation after cardiac arrest are critical from ethical, patient satisfaction, outcome, and healthcare cost standpoints. Physician‐reported discussion barriers include topic discomfort, fear of time commitment, and difficulty articulating end‐of‐life concepts. The influence of language used in these discussions has not been tested. This study explored whether utilizing the alternate term "allow (a) natural death" changed code status decisions in hospitalized patients versus "do not resuscitate" (DNR). Methods: All patients age 65 and over admitted to a general medicine hospital teaching service were screened (English‐speaking, not ICU‐level care, no active psychiatric illness, no substance misuse, no active DNR). Participants were randomized to resuscitation discussions with either DNR or "allow natural death" as the "no code" phrasing. Outcomes included patient resuscitation decision, satisfaction with and duration of the conversation, and decision correlation with illness severity and predicted resuscitation success. Results: 102 participants were randomized to the "allow natural death" (N = 49) or DNR (N = 53) arms. The overall "no code" rate for our sample of hospitalized general medicine inpatients age >65 was 16.7%, with 13% in the DNR and 20.4% in the "allow natural death" arms (p = 0.35). Discussion length was similar in the DNR and "allow natural death" arms (3.9 + 3.2 vs. 4.9 + 3.9 minutes), and not significantly different (p = 0.53). Over 90% of participants were highly satisfied with their code status decision, without difference between arms (p = 0.49). Conclusions: Participants' code status discussions did not differ in "no code" rate between "allow natural death" and DNR arms but were short in length and had high patient satisfaction. Previously reported code status discussion barriers were not encountered. It is appropriate to screen code status in all hospitalized patients regardless of phrasing used. [ABSTRACT FROM AUTHOR]

Drowning is the process of respiratory impairment from immersion or submersion in a liquid. Worldwide, approximately 360,000 deaths annually can be attributed to drowning. Morbidity and mortality are a result of hypoxia, so the focus during resuscitation should be on airway management and optimizing oxygenation. This article describes several drowning scenarios and discusses appropriate response and treatment algorithms. [ABSTRACT FROM AUTHOR]

Background: To better understand the influence of habitat on the genetic content of bacteria, with a focus on members of Candidate Phyla Radiation (CPR) bacteria, we studied the effects of transitioning from soil via seepage waters to groundwater on genomic composition of ultra-small Parcubacteria, the dominating CPR class in seepage waters, using genome resolved metagenomics. Results: Bacterial metagenome-assembled genomes (MAGs), (318 total, 32 of Parcubacteria) were generated from seepage waters and compared directly to groundwater counterparts. The estimated average genome sizes of members of major phyla Proteobacteria, Bacteroidota and Cand. Patescibacteria (Candidate Phyla Radiation – CPR bacteria) were significantly higher in soil-seepage water as compared to their groundwater counterparts. Seepage water Parcubacteria (Paceibacteria) exhibited 1.18-fold greater mean genome size and 2-fold lower mean proportion of pseudogenes than those in groundwater. Bacteroidota and Proteobacteria also showed a similar trend of reduced genomes in groundwater compared to seepage. While exploring gene loss and adaptive gains in closely related CPR lineages in groundwater, we identified a membrane protein, and a lipoglycopeptide resistance gene unique to a seepage Parcubacterium genome. A nitrite reductase gene was also identified and was unique to the groundwater Parcubacteria genomes, likely acquired from other planktonic microbes via horizontal gene transfer. Conclusions: Overall, our data suggest that bacteria in seepage waters, including ultra-small Parcubacteria, have significantly larger genomes and higher metabolic enrichment than their groundwater counterparts, highlighting possible genome streamlining of the latter in response to habitat selection in an oligotrophic environment. [ABSTRACT FROM AUTHOR]

Purpose: According to meta-analytic data, the prognosis of a cancer patient post-cardiopulmonary resuscitation (CPR) is relatively similar to the general population. However, preselection of patients, the details of CPR, patient-specific characteristics, and post-CPR care are poorly described. The aim of this study is to identify prognostic factors in order to recognize cancer patient profiles more likely to benefit from CPR. Methods: This is a retrospective study on a series of patients with solid or hematological malignancies who received CPR between January 2010 and December 2020 in a cancer institute. Results: Sixty-eight patients were included. The ratio of solid to hematological malignancy was 44/24, of which 32 were metastatic solid tumors. Median age was 61 years. Hypoxemia (29%) was the primary factor for cardiac arrest, followed by septic shock (21%). ICU mortality and hospital mortality were 87% and 88% respectively. Younger age, the presence of hematological malignancy, or a metastatic solid tumor were poor predictors for in-hospital mortality. Similarly, cardiac arrest in the ICU, as the final consequence of a pathological process, and a resuscitation time of more than 10 min have a negative influence on prognosis. Conclusions: This study shows that CPR is a useful intervention in cancer patients, even in the elderly patient, especially in non-metastatic solid tumors where cardiac arrest is the consequence of an acute event and not a terminal process. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the significance of cerebro‐placento‐uterine ratio CPUR, a new Doppler index, and fetal cardiac parameters (Mod MPI, EFT) in early–onset preeclampsia (EOPE) and to examine whether these parameters are related to perinatal outcome. Study design: Forty participants diagnosed with EOPE (preeclampsia cases diagnosed before 34 weeks of gestation) and 40 healthy pregnant women were included in this study. Demographic data were recorded. Doppler parameters such as middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (Ut‐A), and left modified myocardial performance index (Mod–MPI) and epicardial fat thickness (EFT) were measured. Cerebroplacental ratio (CPR) was determined by dividing MCA pulsatility index (PI) by UA PI. CPUR was calculated as the ratio of CPR to mean UtA–PI (CPUR = CPR/UtA–PI). All parameters were compared between the EOPE and control groups. Correlation tests were used to examine the relationship between Doppler parameters and perinatal outcome. p values less than 0.05 were considered statistically significant. Results: The pulsatility index of the middle cerebellar artery, CPUR and CPR values were statistically lower in the EOPE group than in the control group (p = 0.002; p = <0.001; p = <0.001; respectively). No statistical differences were found between groups for isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), left mod‐MPI, EFT (p = 0.117; p = 0.093; p = 0.398; p = 0.882; p = 0.202, respectively). Umbilical artery Doppler pulsatility index (PI), mean uterine artery Doppler pulsatility index (PI), were higher in the EOPE group than in the control group (p = 0.006; and p = <0.001, respectively). The CPUR value for predicting EOPE was ≤1.3652 with 74. 4% sensitivity and 94.9% specificity. Positive correlations were found between CPUR, CPR, and some neonatal parameters. Conclusion: CPUR, a new index combining fetal and uterine Doppler indices, may add contribution to predict adverse perinatal outcome and EOPE. [ABSTRACT FROM AUTHOR]

Fulminant myocarditis (FM) is characteristically associated with rapid progressive decline in cardiac function and high mortality, with rapid onset of hemodynamic dysfunction and severe arrhythmias. In this report, we describe a case concerning a patient clinically diagnosed with FM, marked by rapid progression leading to intractable ventricular fibrillation and subsequent cardiac arrest. Conventional cardiopulmonary resuscitation (CCPR) was performed 120 min before extracorporeal membrane oxygenation (ECMO) was initiated. This critical situation was effectively addressed through the utilization of extracorporeal cardiopulmonary resuscitation (ECPR). By providing sustained cardiopulmonary support, effective hemodynamics were obtained. Eventually, the patient made a full recovery, and discharged without neurologic complications on hospital day 13.

The proficiency of trained individuals in effectively administering Cardiopulmonary Resuscitation (CPR) is paramount in mitigating the impact of out-of-hospital cardiac arrest incidents. Inadequate CPR skills among laypersons can result in missed opportunities to save lives. Therefore, it is imperative to prioritize unified efforts to enhance CPR competencies within the general populace. This scoping review aims to consolidate literature discussing the enhancement of laypeople's CPR skills using various methodologies. This scoping review employed the PRISMA methodology and encompassed an extensive search across four critical databases (Science Direct, Proquest, Pubmed, and Google Scholar) for literature published between 2013 and 2023. The search utilized the keywords "CPR Teaching," "Skill," and "Layperson." Out of 487 collected articles, 20 were deemed relevant. The findings of all relevant articles consistently indicated an improvement in laypeople's CPR skills following training. Incorporating concise CPR instructional videos and smartphone applications has shown potential for enhancing CPR knowledge and improving emergency responsiveness. Nonetheless, integrating these modern technological approaches with traditional simulation methods has demonstrated greater efficacy in CPR training, resulting in enhanced compression quality and depth. In conclusion, Integrating traditional and technology-based learning methodologies improves the capability of individuals without specialized medical training to administer CPR effectively.

Aim: The objectives of this study were to assess the return of spontaneous circulation rates and hemodynamic response of large swine (>65Kg) during cardiopulmonary resuscitation after nontraumatic cardiac arrest using the COBRA-OS® aortic occlusion balloon and to address limitations of large swine closed-chest cardiopulmonary resuscitation by comparing closed-chest vs. open-chest cardiopulmonary resuscitation. Methods: Yorkshire pigs (n = 10) weighing >65 kg were anesthetized and ventilated. After 7 min of untreated ventricular fibrillation (VF), animals were randomized to receive mechanical closed-chest cardiopulmonary resuscitation or open-chest cardiac massage. Following a 5-minute low-flow state, advanced cardiac life support algorithms were started and the COBRA-OS® was inflated in the thoracic aorta. Animals that achieved return of spontaneous circulation were re-started on mechanical ventilation and medications, CPR, defibrillation, and aortic occlusion were discontinued. The primary outcome was return of spontaneous circulation and secondary outcomes were mean arterial pressures generated in the low flow and aortic occlusion states before return of spontaneous circulation. Groups were compared with a t-test or Mann-Whitney U test for normal and non-parametric data, respectively, while categorical data was compared with the chi square test. Results: Return of spontaneous circulation was obtained in 4 animals (80%) in the open cardiac massage group and none in the mechanical closed-chest CPR group (p 65 kg) swine models of nontraumatic cardiac arrest. The COBRA-OS® demonstrated feasibility for use in this model.The Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael’s Hospital Animal Care Committee: ACC Protocol #726.

Asbtract: Aim: The aim of our study was to explore the effect of nomination-based social-media campaign and CPR-skill-booth on change in knowledge as well as hands-only CPR skills among young adults. Methods: A quasi-experimental study was conducted in two non-healthcare-stream colleges, one intervention and other control arm. After baseline evaluation of CPR knowledge in both colleges, a 4-week nomination-based social media campaign ‘#CPR challenge’ was rolled out in the intervention arm which included a CPR-skill-booth that was setup for one hour every day to train interested participants in CPR. The participants were encouraged to share the same on their social media handles and data of self-reported metrics were collected. A post-intervention assessment was conducted in both arms, to assess knowledge and its translation to hands-only-CPR skills using qCPR mannequin and qCPR app® for objective assessment. Results: A total of 690 assessments were done; Intervention arm (pre-intervention-214, post intervention −155) and control arm (pre-intervention −157, post-intervention −134). The baseline knowledge scores were comparable in both groups. Knowledge score doubled in the intervention arm, (p

Background: The “chain of survival” was first systematically addressed in 1991, and its sequence still forms the cornerstone of current resuscitation guidelines. The term “chain of survival” is widely used around the world in literature, education, and awareness campaigns, but growing heterogeneity in the components of the chain has led to confusion. It is unclear which of these emerging chains is most suitable, or if adaptations are needed in particular contexts to depict key actions of resuscitation in the 21st century. This scoping review provides an overview of the variety of chains of survival described. Objectives: To identify published facets of the chain of survival, to assess views and strategies about adapting the chain, and to identify reports on how the chain of survival affects teaching, implementation, or patient outcomes. Methods, eligibility criteria, and sources of evidence: A scoping review as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) was conducted. MEDLINE(R) ALL (Ovid), Embase (Ovid), APA PsycINFO (Ovid), CINAHL (Ebscohost), ERIC (Ebscohost), Web of Science (Clarivate), Scopus (Elsevier), and Cochrane Library (Wiley Online) were searched. All publications in all languages describing chains of survival were eligible, without time restrictions. Due to the heterogeneity and publication types of the relevant studies, we did not pursue a systematic review or meta-analysis. Results: A primary search yielded 1713 studies and after screening we included 43 publications. Modified versions of the chain of survival for specific contexts were found (e.g., in-hospital cardiac arrest or paediatric resuscitation). There were also numerous versions with minor adaptations of the existing chain. Three publications suggested an impact of the use of the chain of survival on patient outcomes. No educational or implementation outcomes were reported. Conclusion: There is a vast heterogeneity of chain of survival concepts published. Future research is warranted, especially into the concept’s importance concerning educational, implementation, and clinical outcomes.

Abstract Background Currently, the data regarding the impact of prehospital postcardiac arrest anesthesia on target hemodynamic and ventilatory parameters of early postresuscitation care and recommendations on its implementation are rare. The present study examines the incidence and impact of prehospital postcardiac arrest anesthesia on hemodynamic and ventilatory target parameters of postresuscitation care. Methods In this multicentre observational study between 2019 and 2021 unconscious adult patients after out-of-hospital-cardiac arrest with the presence of a return-of-spontaneous circulation until hospital admission were included. Primary endpoint was the application of postarrest anesthesia. Secondary endpoints included the medication group used, predisposing factors to its implementation, and its influence on achieving target parameters of postresuscitation care (systolic blood pressure: ≥ 100 mmHg, etCO2:35–45 mmHg, SpO2: 94–98%) at hospital handover. Results During the study period 2,335 out-of-hospital resuscitations out of 391,305 prehospital emergency operations (incidence: 0.58%; 95% CI 0.54–0.63) were observed with a return of spontaneous circulation to hospital admission in 706 patients (30.7%; 95% CI 28.8–32.6; female: 34.3%; age:68.3 ± 14.2 years). Postcardiac arrest anesthesia was performed in 482 patients (68.3%; 95% CI 64.7–71.7) with application of hypnotics in 93.4% (n = 451), analgesics in 53.7% (n = 259) and relaxants in 45.6% (n = 220). Factors influencing postcardiac arrest sedation were emergency care by an anesthetist (odds ratio: 2.10; 95% CI 1.34–3.30; P

Abstract Background The occurrence of pulmonary visceral subpleural hematoma during care of post-cardiopulmonary resuscitation including chest compressions and anticoagulant and antiplatelet therapies is extremely rare. Also, there are few reports of treatment of visceral subpleural hematoma, most of which are treated by lung resection. Here we describe a rare case that pulmonary visceral subpleural hematoma arose during post-cardiopulmonary resuscitation care and was treated by hematoma evacuation. Case presentation A 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course. Conclusions Pulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully.

Background: Cardiac arrest is a crucial problem because it has a short rescue time and requires optimal assistance competence. The global incidence of cardiac arrest is 50-60 per 100,000 per year, while in Indonesia it is 10,000 per year or 30 incidents every day. This is an important problem that must be addressed immediately, apart from improving skills, by using innovative supporting tools. This tool is still very limited and does not even exist in Indonesia.Objectives: To determine the effectiveness of digital resuscitation pads (petitions) on the accuracy of compression of cardiac and pulmonary resuscitation.Methods: The number of samples in this study was 46 respondents as the case group and as the control group. In the case group, we provided the innovative Digital Resuscitation Pad tool and the rhythm of tapping to perform compressions, while in the control group they were only guided by the rhythm of tapping. The inclusion criteria include respondents who have practiced CPR for lay people appropriately. The instrument uses a questionnaire with a validity test of r table 0.621 and reliability r table 0.539. The analysis uses the Wilcoxon test using total sampling.Results: Based on the researchers' findings in this research, in the control group, 56.52% of respondents performed inappropriate compression, meaning that 26 respondents, more than half of the respondents provided compression that was not of good quality. After being given the Digital Resuscitation Pad, compression quality increased to 86.95% or 29 respondents provided quality compression.Conclusions: There is an influence of the Digital Resuscitation Pad on the accuracy of Cardiac and Pulmonary Resuscitation compressions. Researchers concluded that the Pad Digital Resuscitation device could improve the quality of student compressions over a measurable distance even though BMI indirectly plays an important role in nurses' performance in providing optimal cardiopulmonary resuscitation

Back ground Code Blue is a common emergency code used in cases of cardiac arrest in hospitals to alert trained emergency response teams. The use of codes is mainly to convey essential information quickly to staff while preventing misunderstandings and panic among hospital visitors. This study aimed to determine the profiles and outcomes of patients with activated code blue calls. Methods This retrospective record-based study included all patients who had a code blue declared in the year 2022. Data was collected from the patient files from medical records department and analyzed with descriptive and inferential statistical methods. Results A total of 86 code blue calls were analyzed in this study. In terms of age distribution, the age group 60-80 years had the highest percentage of code blue cases. Code blue cases were more announced in males in the study (55.8%). For the announced code blue cases, it was identified that CPR if initiated by the staff on scene before the arrival of the code blue team had higher survival chance (60.0%). Asystole was the most common rhythm detected initially (66.3%) upon arrival of the code blue team. It was found that if the response time was lesser than 2 min, the patients had a higher chance of survival (53.3%). Conclusions In conclusion, CPR performed by a trained code blue team in a hospital can help improve outcomes. The initiation of bystander CPR has been proven to have favorable outcomes. Better training of staff can result in better outcomes.

Background: Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest. Methods: This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines. Results: 36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques. Conclusion: The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.

Background: Success in resuscitation depends not only on the timeliness of the maneuvers but also on the quality of chest compressions. Factors such as the rescuer position and arm angle can significantly impact compression quality. Aim: This study explores the influence of rescuer positioning and arm angle on the quality of chest compressions among healthcare professionals experienced in cardiopulmonary resuscitation. Methods: In this international, multicentric, randomized crossover simulation trial with independent groups, healthcare professionals were assigned to one of four positions: kneeling on the floor, standing, standing on a step stool, and kneeling on the bed. Participants performed two 3-minute trials of uninterrupted chest compressions at arm angles of 90° and 105°. Compression quality was assessed, using manikin derived data. Results: A total of 76 participants entered the study. Those using a 90° arm angle exhibited higher compression scores than those at a 105° angle. Rescuers standing on a step stool maintained higher scores over time when compared to other groups. In contrast, rescuers kneeling on the bed consistently scored below 75% throughout the trial, with particularly low scores at the 105° angle. Conclusion: Rescuer position and arm angle significantly influence CPR quality, with a 90° arm angle and elevated positioning optimizing compression depth and effectiveness. The results recommend against kneeling on the bed due to its negative impact on chest compression quality.

Background: Cardiopulmonary resuscitation (CPR) is essential for saving lives during cardiac arrest, but performing CPR in extreme environments poses unique challenges. In scenarios ranging from hypogravity or microgravity to confined spaces like aeroplanes and underwater scenarios, traditional CPR techniques may be inadequate. This scoping review aims to identify alternative chest compression techniques, synthesise current knowledge, and pinpoint research gaps in resuscitation for cardiac arrest in extreme conditions. Methods: PubMed and the Cochrane Register of Controlled Trials as well as the website of ResearchGate was searched to identify relevant literature. Studies were eligible for inclusion if they evaluated alternative chest compression techniques, including manual or mixed CPR approaches, whilst assessing feasibility and effectiveness based on compression depth, rate, and/or impact on rescuer effort. Results: The database search yielded 9499 references. After screening 26 studies covering 6 different extreme environments were included (hypogravity: 2; microgravity: 9, helicopter: 1, aeroplane: 1, confined space: 11; avalanche: 2). 13 alternative chest compression techniques were identified, all of which tested using manikins to simulate cardiac arrest scenarios. Conclusion: To address the unique challenges in extreme environments, novel CPR techniques are emerging. However, evidence supporting their effectiveness remains limited.

Background: There is an emerging concern regarding the indirect effect the Covid-19 pandemic has had on the care provided to patients. New resuscitation guidance including the donning of Personal Protective Equipment before commencing resuscitation efforts, the avoidance of bag-mask ventilation, limiting the number of responders and stopping resuscitation efforts earlier could have led to worse outcomes following in-hospital cardiac arrest (IHCA) when compared to the non-pandemic period. The primary objective was to understand the impact of the pandemic on patient outcomes following IHCA by comparing the pandemic and non-pandemic periods. Methods: Our systematic search was conducted on the 13th of September 2022 in three databases: Medline, Embase and Central. Randomised or non-randomised clinical trials and observational studies were included. The search was repeated on 31st December 2023 and there were no new studies appropriate for inclusion which had been published in the interim. The patient population consisted of adult patients who suffered IHCA due to any cause. The primary outcome was survival to hospital discharge (SHD). The secondary outcomes were return of spontaneous circulation (ROSC) and length of resuscitation. Results: We identified 1873 studies, 9 were included in our qualitative analysis. SHD was reported in 8 studies with no difference between the two periods (OR 0.69; 95% CI 0.47–1.03) along with resuscitation (MD: 0.74; 95% CI: −0.67 to 2.14; p = 0.153. ROSC was included in all studies and showed significant difference between the two periods (OR 0.75; 95% 0.60–0.95) Conclusion: Although SHD was similar between the two periods, ROSC was significantly lower during the pandemic with longer resuscitation times highlighting a substantial impact of the pandemic on patient outcomes.

Introduction: Cardiopulmonary resuscitation is a technique of the basic life support, which helps to maintain blood circulation in the victim's brain and heart during cardiac arrest or during the absence of pulse and breath. Adults are more active and long-time information delivers, but non-medical people are not having the knowledge regarding emergencies managements, hence this study was conducted to assess the knowledge and check the effectiveness of structured teaching programme regarding CPR among GNM students. Aim: To provide Knowledge about CPR to the students of GNM. Objective: To assess the knowledge of the GNM students about CPR. METHODOLOGY:Sample was taken by universal sampling technique Sample size was 90 GNM students include male and female (all GNM students). A Self-structured questionnaire technique was used to collect the baseline data, and data for the knowledge of the students about CPR. Result showed that Maximum students (64%) were in age 21 years. Majority of students (77.6%) were females. Maximum students (50%) had below average knowledge regarding cardio pulmonary resuscitation. Only (40%) students had average knowledge regarding cardio pulmonary resuscitation. Maximum students (60%) had good knowledge regarding cardio pulmonary resuscitation. The study concluded that Only (40%) students had average knowledge regarding cardio pulmonary resuscitation and Maximum students (60%) had good knowledge regarding cardio pulmonary resuscitation. [ABSTRACT FROM AUTHOR]

Introduction: The life-saving procedure, Cardiopulmonary resuscitation (CPR), is only applied in 30% of cardiac arrest cases as a result of many factors, such as lack of knowledge and fear of causing further damage. Due to the importance of immediate application of CPR, some National First Aid Centres around the world provide the necessary instructions to the potential rescuer by telephone to overcome any obstacles and difficulties (Telecommunication CPR - TCPR) appear. Aims: The aim of the study was to investigate the knowledge and experience of the subjects' participation in a simulated cardiac arrest scenario in which they applied CPR guided by telephone instructions. Methodology: This was a cross-sectional study of subjects who were asked to perform CPR, with chest compressions only, following telephone instructions in response to a simulated cardiac arrest incident scenario. Before and after their participation, they completed specific questionnaires measuring their opinion and knowledge about CPR. The statistical package SPSS ver.24 was used to analyse the results. The significance level was set at p<0.05. Results: The sample was consisted of 151 people with an average age of 38 years (58,9% male VS 41,1% female). The 90.7% (n=137) were not health professionals as well as the 83.4% of respondents (n=126) knew what CPR was. The 76.2% of participants had no previous training in CPR. The 97.7% (n=138) felt that the telephone instructions were easy to understand while among those who had previously been trained in CPR, the 33 (91.7%) said that the previous knowledge they had was helpful in combination with the provided telephone instructions. Finally, 57% (n=86) of the participants experienced anxiety. Conclusions: Overall, through the current research it is demonstrated that the telephone instructions are easy to understand and implement as the overall process was described as easy, although more than half of the participants experienced anxiety. It is important to note that the majority of the participants with previous training in CPR, stated that their previous knowledge combined with the telephone instructions, helped them cope with the experiment. [ABSTRACT FROM AUTHOR]

Background: The occurrence of pulmonary visceral subpleural hematoma during care of post-cardiopulmonary resuscitation including chest compressions and anticoagulant and antiplatelet therapies is extremely rare. Also, there are few reports of treatment of visceral subpleural hematoma, most of which are treated by lung resection. Here we describe a rare case that pulmonary visceral subpleural hematoma arose during post-cardiopulmonary resuscitation care and was treated by hematoma evacuation. Case presentation: A 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course. Conclusions: Pulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the preferences of small animal veterinary clients for the timing of communication during CPR and whether these clients prefer the veterinarian or pet owner to decide on the termination of resuscitation. SAMPLE Surveys (n = 1,648) were completed between January 20 and February 3,2023, by clients of the Wilford and Kate Bailey Small Animal Teaching Hospital. METHODS: This cross-sectional observational study used an anonymous internet-based survey distributed to 28,000 clients of an academic small animal veterinary hospital. The survey included 16 questions asking for the respondents' demographics, healthcare professional status, questions pertaining to CPR, and preference for timing of communication during CPR, veterinary team members to speak to, and the decision on termination of resuscitation. An optional open comment section was provided. RESULTS: The response rate was 7.5%, including 2,127 responses, with 1,648 complete responses used for further analysis. Of the respondents, 56% and 63% (when asked using a short and long scenario question, respectively) would prefer to be informed about their pet undergoing CPR after CPR has ended. Most clients (84%) wanted the veterinarian to decide when to stop CPR. In the comments section, clients predominantly emphasized that patient care should always be prioritized over client communication. CLINICAL RELEVANCE: This study contributes to a better understanding of veterinary clients' preferences and may help improve client communication and decision-making during CPR. More studies are warranted to reach a wider population before broad recommendations can be made. [ABSTRACT FROM AUTHOR]

The implementation of educating "Basic Life Support (BLS) competences" in German schools is particularly affected by the often reported "implementational gap" --limited transfer of empirical findings into practice. This Design-Based Research (DBR) study evaluates two different methodologies for BLS teaching, generating implications for transfer. Students (N = 136) of a secondary school (11-13 years) were assigned to different methodological approaches. A test group (TG) received intervention implemented into regular biology lessons (10 units; n = 48); the control group (CG) participated in a basic instruction (2 units; n = 68). Both large-scale methods -- subject-matter teaching (TG) and project activity (CG) -- were compared regarding current motivation, self-efficacy, constructivist instruction, cognitive load, and practical skills. Data from n = 125 students (TG = 48; TG = 68) could be included into analysis (Mage = 11,16; SD = .45; 55.2% female). Probability of success and interest increased, anxiety perception decreased (no group-interaction effect), whereas challenge perception remained constantly. Self-efficacy overall improved from before to after intervention, with TG reporting higher social self-efficacy and less negative outcome expectancies. No differences were found for practical BLS performance. MANOVA (after intervention) showed higher values for anxiety in TG, and for self-efficacy, CG has higher values for negative outcome expectancies (post hoc analysis). For cognitive load and constructivist instruction, no differences between groups were found. In conclusion, both methodological approaches seem to have their own pedagogical justification. Schools' implementation processes may benefit from combining (subject-matter) curriculum content with BLS information or content to facilitate time and resource-saving realization. [ABSTRACT FROM AUTHOR]

Smart glasses allow care providers to connect to remote experts for consultation and have the potential to improve care. The purpose of this study was to evaluate the user experience with smart glasses in a simulated nursing care environment. We collected data via post-simulation semi-structured interviews and System Usability Scale (SUS) surveys. The median SUS score was 74 (range 57.5 to 90). The qualitative and quantitative findings of our study highlighted the potential benefits of smart glasses for assisting novice nurses in patient care, as well as the technical and workflow challenges that need further investigation. [ABSTRACT FROM AUTHOR]

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The Continuous Plankton Recorder (CPR) survey is a valuable resource for mapping changes in plankton distribution and understanding harmful algal ecology because of its breadth and longevity. Preservation methods with formalin degrade DNA, making it difficult to use as a molecular tool for archived marine samples. DNA was extracted from CPR samples immediately after collection, seven months later and after nine years of storage from a cruise track along the Iberian Peninsula. PCR reactions performed from the nine-year timepoint were hybridized to probes in an electrochemical biosensor and compared to results obtained from RT-PCR performed at two earlier time points. The successful identification of Pseudo-nitzschia spp., Prorocentrum lima, Alexandrium minutum, Alexandrium ostenfeldii, Gambierdiscus spp. and Coolia spp. was documented. The biosensor analysis outperformed RT-PCR, allowing us to document certain tropical toxic dinoflagellates, viz., Gambierdiscus and Coolia, that produce human ciguatoxins and Coolia toxins, respectively. These non-native algal toxins can accumulate, pervade the food web and negatively impact human food security. This supports the northerly movement of microalgae with climate change in offshore Iberian peninsular waters. This study highlights biosensors as a cost-effective tool for the offshore monitoring of HAB species and advances molecular technologies for long-term CPR datasets that have limited records of harmful algae. DNA from formalin-preserved CPR samples is degraded, so the use of a short, multiprobe biosensor can augment historical plankton records with contemporary methods that also capture infrequently occurring benthic taxa carried in surface waters. The integration of probe-based biosensor technologies offers a promising avenue for exploring plankton dynamics in response to environmental changes. [ABSTRACT FROM AUTHOR]

Objective: To determine in adult chickens which of 3 CPR techniques, sternal compressions (SC), SC with interposed caudal coelomic compressions (ICCC), or lateral compressions (LC), results in the highest mean systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as measured directly from the carotid artery. Design: Prospective, nonblinded, experimental crossover study. Setting: University teaching hospital laboratory. Animals: Ten retired laying hens. Interventions: Birds were sedated, anesthetized, and placed in dorsal recumbency. A carotid artery catheter was placed to directly measure arterial pressure. Ventricular fibrillation was induced with direct cardiac stimulation using a 9‐Volt battery. Each bird then received 2 minutes of the 3 different cardiac compression techniques in a random order by 3 different compressors, with the compressor order also randomized. Birds were subsequently administered IV epinephrine, and transthoracic defibrillation was attempted. At the end of experimentation, each bird was euthanized, and simple gross necropsies were performed. Linear mixed models followed by pairwise paired t‐tests were performed to evaluate differences in pressures generated by each technique. Measurements and Main Results: The primary study outcomes were SAP, DAP, and MAP over 2 minutes of compressions for each compression technique. Pressures from ICCC (SAP: 27.6 ± 5.3 mm Hg, DAP: 18.7 ± 5.2 mm Hg, MAP: 21.7 ± 5.2 mm Hg) were significantly higher than those from LC (SAP: 18.9 ± 5.4 mm Hg, DAP: 11.6 ± 4.1 mm Hg, MAP: 14.1 ± 4.5 mm Hg). Pressures from SC (SAP: 24.5 ± 6.4 mm Hg, DAP: 15.2 ± 4.3 mm Hg, MAP: 18.3 ± 5.0 mm Hg) were not significantly different from ICCC or LC. Conclusions: External compressions can generate detectable increases in arterial pressure in chickens with ventricular fibrillation. SC with ICCC generated significantly higher arterial pressures than LC. SC alone generated blood pressures that were not significantly different from those generated by SC with ICCC or LC. [ABSTRACT FROM AUTHOR]

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]