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Introduction: The instructor-led CPR training method has been used for over 4 decades. However, nurses' knowledge and skills are still low. Instructor-led CPR training is an extremely capital-intensive programme that requires more time, workforce, and space, thus serving as an impediment to effective learning among the prospective nurses' trainees. Self-directed training method is suggested to improve the knowledge and skills of CPR among healthcare practitioners due to the low cost and flexibility. This study aims to evaluate the effectiveness of self-directed method in improving nurses' knowledge and skill retention from baseline to post-test, one, three-, and six months. Method: A two-arm double-blinded randomised controlled trial will be conducted in two referral hospitals. The control group training consists of a one-day session taught by AHA-certified instructors, whereas the intervention group training entails participants learning on computers in a simulation lab for seven days. A generalised estimated equation model will be used for statistical analysis. Discussion: Through the self-directed training method, participants will have significantly better knowledge and skills of CPR compared to the conversational training method across the time points. Self-directed training method is a simple, cost-effective and flexible method, which can facilitate the training of more nurses in the acquisition and retention of knowledge and skills, especially for those who prefer to learn at their own pace. [ABSTRACT FROM AUTHOR]

Introduction An electronic resuscitation system, implemented in 2015, within electronic patient records (EPR) at King's College Hospital NHS Foundation Trust was studied, aiming to review and improve decision documentation and communication. Method The study (January 2018 -- June 2018) included all gerontology inpatients with electronic do not attempt cardiopulmonary resuscitation (e-DNACPR) decisions. Cases were identified weekly, followed by retrospective analysis of discharges. Amendments to the electronic system and improvements were implemented between cycles. Cycle 1 One-hundred and thirty-three patients were included; 85% had an e-DNACPR form; 86% of all forms had senior doctor involvement; 68% evidenced patient/relative discussion; 13% documented multidisciplinary team (MDT) discussion. Interventions A mandatory 'named nurse' field was added to the form and trust-wide education programme implemented. Cycle 2 One-hundred and twenty-six patients were included; 100% had an e-DNACPR form; 93% evidenced senior doctor involvement; 71% evidenced patient/relative discussion; 57% documented MDT discussion. Conclusion Changes to the process and trust-wide education resulted in more robust documentation and communication. [ABSTRACT FROM AUTHOR]

Background: Because of the complexity, stressfulness, and the threatening nature of the working environment of prehospital Emergency Medical Technicians (EMTs), they encounter many ethical challenges during making decisions and providing quick and accurate care to patients. The present study aimed to investigate the ethical challenges among prehospital EMTs. Materials and Methods: To review all published studies, we searched SID, Medlib, Iran Medex, Magiran, Web of Science, Medline, Google Scholar, CINAHL, PubMed, Ovid, and Scopus databases from 2000-18. The keywords were "ethical challenges", "emergency medical technicians", and "prehospital emergency". Results: According to the evaluation of the studies, the ethical challenge regarding prehospital emergencies included decision over dispatching an ambulance to the scene, cardiopulmonary resuscitation, triage in crisis and disaster, irrational interventions of the patient or patient's family, intervention in accordance with patient's informed consent, and safe driving. Conclusion: Considering the unique conditions of prehospital caring, identifying, and discovering the ethical conflicts in this field of the health care system and providing the appropriate solution are very important. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterial and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo explore literature, policies or procedures available to care providers on how to deliver CPR and BLS to people with a disability, for whom the current standard guidelines are not fit for purpose.A scoping review was conducted using four databases, namely, CINHAL, PubMed, Scopus, Medline and Google Scholar. Keywords used included, disab*, wheelchairs, cardiopulmonary, resuscitation, “basic life support”, life support care, and bystander CPR. 1119 papers were retrieved and 1043 were screened following removal of 76 for duplication. 18 full text articles were reviewed and 5 met the inclusion criteria.The five articles were from three counties and included one case study, three expert opinion papers and one intervention study. Four of the papers advocated in favour of improved CPR and BLS guidelines and three of the papers discussed techniques and ideas for supplementation of standard CPR and BLS.The scoping review has uncovered a paucity of evidence explaining delivery of CPR and BLS for people with disability and highlights the need for further research. In the absence of further evidence, it is reasonable for educators to provide ideas and discussion about supplementing CPR and BLS for people with disability to carers.People with disability and wheelchair users are at a high risk for premature or preventable deaths.Improved first aid responses are proposed to be a mitigating factor for premature and preventable deaths.Improved first aid responses will afford people with disability and wheelchair users the same opportunities for care and rehabilitation as people without disability.Formal and informal carers do not currently have prescriptive guidelines to improve their knowledge on responding to emergency events for people with disabilities.Development of improved guidelines is recommended to reduce fear and anxiety for formal and informal carers whilst also increasing their confidence to respond to emergency situations.People with disability and wheelchair users are at a high risk for premature or preventable deaths.Improved first aid responses are proposed to be a mitigating factor for premature and preventable deaths.Improved first aid responses will afford people with disability and wheelchair users the same opportunities for care and rehabilitation as people without disability.Formal and informal carers do not currently have prescriptive guidelines to improve their knowledge on responding to emergency events for people with disabilities.Development of improved guidelines is recommended to reduce fear and anxiety for formal and informal carers whilst also increasing their confidence to respond to emergency situations. [ABSTRACT FROM AUTHOR]

This paper examines the recent policy update by the College of Physicians and Surgeons of Ontario (CPSO), which allows physicians to override patient wishes for cardiopulmonary resuscitation (CPR) without consent. It critically analyzes the ethical implications of this shift, emphasizing the juxtaposition between the legal protections for patient’s Last Wills and the relatively diminished safeguarding of their end-of-life care preferences. The paper highlights the potential for bias in physician decision-making, the risk of reverting to a more paternalistic healthcare model, and the challenge of balancing patient autonomy with medical authority. The study underscores the need for a nuanced approach to healthcare policy that respects patient autonomy while addressing the complexities of end-of-life decisions. [ABSTRACT FROM AUTHOR]

This paper deals with changes in code status policy in Ontario and endorses a new College of Physicians and Surgeons of Ontario (CPSO) policy. We argue that the recent policy changes in this area necessitate an active educational strategy around end-of-life care to prevent harm to dying patients. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is a global health problem that requires, in many cases, cardiopulmonary resuscitation (CPR) and automatic external defibrillation (AED). Generally, it is initiated by a witness and continued by trained personnel. Many of the patients who suffer from SCD have a history of cardiac problems, and the decision to start CPR bystander must be made in seconds, which entails medical and bioethical decisions. Some of these decisions involve not only the initial rescuer but also health personnel and the family, and everyone must be conscious that a patient's death is possible. The objective of this paper is to mention the main bioethical considerations that are directly related to CPR, both the people who receive it and those who administer it in the context of SCD. [ABSTRACT FROM AUTHOR]

Background: Performing cardiopulmonary resuscitation in non‐critical care hospital wards is a stressful event for the registered nurse; stress may negatively affect performance. Delays in initiating basic life support and following current basic life support algorithms have been reported globally. Aim: The aim of this review was to investigate factors that can affect registered nurses' experiences of performing basic life support. Methods: Using the five‐step integrative literature review method from Whittemore and Knafl, this review searched articles published between January 2000 and June 2022 for qualitative and quantitative primary studies from the databases CINAHL Complete (EBSCO), Medline (Web of Science), Scopus and PubMed. Results: Nine studies from eight countries met the inclusion criteria and were appraised here. Five themes relating to factors affecting the performance of basic life support were found during this review: staff interaction issues, confidence concerns, fear of harm and potential litigation, defibrillation concerns and basic life support training issues. Conclusions: This review revealed several concerns experienced by registered nurses in performing basic life support and highlights a lack of research. Factors affecting nurses' experiences need to be understood. This will allow education to focus on consideration of human factors, or non‐technical skills during basic life support training, as well as technical skills, to improve outcomes for patients experiencing an in‐hospital cardiopulmonary arrest. Summary statement: What is already known about this topic? In‐hospital basic life support is not always performed at expected levels.There is very little information on factors affecting registered nurses' experiences in performing basic life support, especially in non‐critical areas.Although human factors, such as teamwork, have recently been added to cardiopulmonary resuscitation education, these are poorly understood regarding ward nurses' real‐life experiences. What this paper adds? Factors impacting registered nurses' performance of basic life support in non‐critical care wards included staff interaction issues, confidence concerns, fear of harm and potential litigation, defibrillation concerns and basic life support training issues. The implications of this paper: Factors affecting nurses in performing basic life support need to be understood in order to improve performance.The identification of barriers from the literature allows educators to include targeted discussion and education within basic life support training to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Medical emergency situations in dental clinics have been contemplated to be an issue in most of the countries by reason of dentist's lack of knowledge and preparedness to attend emergency situations in dental offices. The aim of this paper is to observe the knowledge, attitude, and perceived confidence of the general dental practitioners regarding emergency medical care and its practical application. Questionnaire on knowledge assessment was circulated among 500 dentists using printed questionnaire formats and various social media platforms. The questionnaire included details on treating hypertensive patients, cardiopulmonary resuscitation training, accessibility of medical emergency equipments in the dental clinics, prevalence of medical emergency cases in the dental office and the self-assessed competence to handle medical emergency situations in the dental clinics. Data was surveyed and scrutinized using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Descriptive statistics was tabulated and Chi square tests was applied. Findings: 500 general dental practitioners pan India were involved in the study (294 were females and 207 were males). They were grouped into different age groups (20–30 yrs, 30–40 yrs, 40–50 yrs, 50 and above) and experience (0–5 yrs, 5–10 yrs and more than 10 years). 279 participants did not attend any medical emergency training whereas, 222 participants from all groups attended training program. It was observed that with increased experience in the field, the knowledge, awareness and confidence to treat medical emergency situation in the dental clinics was better. Dentists should update themselves from time-to-time with the latest technologies in the field and need to attend training programs to handle any medical emergency situations in the dental offices. Medical emergencies in a dental clinic can be encountered at any point of time and the clinician should have apt knowledge in handling such situations. Majority of the dentists feel subdued in managing medical situations in dental offices. Training and workshops for handling medical situations in the dental offices should be mandated at the undergraduate and postgraduate levels. This will help the dentist to shape one's confidence in managing such situations without apprehension. Availability of proper infrastructure and equipments is recommended in every dental clinics so as to ease the handling of the situation. Conclusion: This paper enlightens the need of basic life support training on regular basis among the dentists to improve the competence among them and to improve the confidence in handling such situations. [ABSTRACT FROM AUTHOR]

Ultrasound is used in cardiopulmonary resuscitation (CPR) and advanced life support (ALS). However, there is divergence between the recommendations of many emergency and critical care societies who support its use and the recommendations of many international resuscitation organizations who either recommend against its use or recommend it only in limited circumstances. Ultrasound offers potential benefits of detecting reversable causes of cardiac arrest, allowing specific interventions. However, it also risks interfering with ALS protocols and increasing unhelpful interventions. As with many interventions in ALS, the evidence base for ultrasound use is weak, and well-designed randomized trials are needed. This paper reviews the current theory and evidence for harms and benefits. [ABSTRACT FROM AUTHOR]

Objective To explore the public's cognition and attitude towards general medicine, general practitioners, and pre-hospital first-aid knowledge in Ludian County, Yunnan Province, to find out the training and learning methods that are more acceptable to the public for this kind of related knowledge, and to propose targeted solutions. Methods A complete random sampling survey was conducted among the nucleic acid collection office at the gate of the vegetable market from October 15, 2022, to December 30, 2022, and the outpatient clinic of Wenping Street Health Center from January 1, 2023, to February 28, 2023, by using electronic questionnaire and paper questionnaire. Results Nearly 50% of the people in Ludian County of Yunnan Province lack the knowledge of general medicine and pre-hospital emergency care, especially the knowledge of electrical defibrillation. People with higher education and the medical profession have a higher understanding of general medicine, and people with a higher understanding of general medicine are more willing to participate in pre-hospital emergency care. The average Ridit value is: very familiar with general medicine (0.774)> Knowledge of some general practices (0.565) > Never heard of general practice (0.400). The higher education level and the more comprehensive understanding of general medicine had a positive impact on participation in pre-hospital emergency care, with B values of 0.624 and 0.619, OR 95%CI of 1.867 (1.544 ~ 2.257) and 1.857 (1.298 ~ 2.657), respectively. Taking medical staff as a reference, the B value of medical students was = 0.942, P = 0.234, the difference was not significant, and the B value of non-medical professional population was all less than 0, the effect is negative. In addition, most people have a positive attitude towards learning pre-hospital first aid, and more than 70% of people are willing to learn and train related knowledge of pre-hospital first aid. Conclusions People in urban areas of Ludian County, Yunnan Province have poor understanding of general practice, low recognition of general practitioners, low demand for general practitioners, and lack of awareness of the importance of pre-hospital emergency treatment. Because of the cognitive differences among different groups, it is necessary to conduct specific training for different groups. [ABSTRACT FROM AUTHOR]

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: Cerebral ischemia/reperfusion injury is a common secondary effect of cardiac arrest which is largely responsible for postresuscitative mortality. Therefore development of therapies which restore and protect the brain function after cardiac arrest is essential. Methylene blue (MB) has been experimentally proven neuroprotective in a porcine model of global ischemia-reperfusion in experimental cardiac arrest. However, no comprehensive analyses have been conducted at gene expression level. Methods: Pigs underwent either untreated cardiac arrest (CA) or CA with subsequent cardiopulmonary resuscitation (CPR) accompanied with an infusion of saline or an infusion of saline with MB. Genome-wide transcriptional profiling using the Affymetrix porcine microarray was performed to 1) gain understanding of delayed neuronal death initiation in porcine brain during ischemia and after 30, 60 and 180 min following reperfusion, and 2) identify the mechanisms behind the neuroprotective effect of MB after ischemic injury (at 30, 60 and 180 min). Results: Our results show that restoration of spontaneous circulation (ROSC) induces major transcriptional changes related to stress response, inflammation, apoptosis and even cytoprotection. In contrast, the untreated ischemic and anoxic insult affected only few genes mainly involved in intra-/extracellular ionic balance. Furthermore, our data show that the neuroprotective role of MB is diverse and fulfilled by regulation of the expression of soluble guanylate cyclase and biological processes accountable for inhibition of apoptosis, modulation of stress response, neurogenesis and neuroprotection. Conclusions: Our results support that MB could be a valuable intervention and should be investigated as a therapeutic agent against neural damage associated with I/R injury induced by cardiac arrest. [ABSTRACT FROM AUTHOR]

The article discusses the NAP7 (National Audit Project 7) papers on peri-operative cardiac arrest. The author addresses criticism that there have been too many NAP7 papers, stating that all 12 papers went through peer review and were judged to meet publication standards. The papers were disseminated through various means, including open-access publishing, social media, author interviews, and podcasts. The author emphasizes the importance of reading the main results papers and specialist papers relevant to one's area of practice. The article provides references to specific papers on topics such as obstetrics, anaphylaxis, airway management, and resuscitation decisions. [Extracted from the article]

Background: Out-of-hospital cardiac arrest is considered a global problem. In the last few years, there has been a growing interest in telephone-cardiopulmonary resuscitation guided by a telecommunicator. Indeed, several studies have demonstrated that it increases the chances of survival rate. This study focuses on the key points the operator should follow when performing telephone-cardiopulmonary resuscitation. The main objective of this paper is to design an algorithm to improve the telephone-cardiopulmonary resuscitation response protocol. Methods: The available evidence and the areas of uncertainty that have not been previously mentioned in the literature are discussed. All the information has been analyzed by two discussion groups. Later, a consensus was reached among all members. Finally, a response algorithm was designed and implemented in clinical simulation. Results: All the witnesses were able to recognize the OHCA, call for emergency assistance, follow all the operator's instructions, move the victim, and place their hands in the correct position to perform CPR. Discussion: The results of the pilot study provide us a basis for further experimental studies using randomization and experimental and control groups. Conclusions: No standardized recommendations exist for the operator to perform telephone-guided CPR. For this reason, a response algorithm was designed. [ABSTRACT FROM AUTHOR]

Training of first responders in cardiopulmonary resuscitation and the use of the automated external defibrillator should be designed to maximise retention of acquired knowledge. The objective of this study was to investigate whether the use of elearning as a supplement to face-to-face training can lead to better knowledge retention among training participants than face-to-face training alone. A quasi-experiment was conducted between May 2017 and February 2018. Both the intervention and control groups participated in two days of training (totalling ten hours). The intervention group also participated in an additional 15-minute e-learning course. The knowledge of all participants was assessed immediately after the training and six months after the training with a paper-based test. The use of an e-learning course to supplement face-to-face instruction resulted in a significant positive improvement in knowledge retention. After a period of six months, a statistically significant decrease in test scores was observed in the control group (p = 0.005), in contrast to the intervention group (p = 0.114). The use of e-learning as a supplement to face-to-face training could be a valid approach to improve knowledge retention among course participants. [ABSTRACT FROM AUTHOR]

The Objective Structured Clinical Exam (OSCE) is an assessment tool used as a reliable method for clinical competence evaluation of students. This paper presents an investigation focused on the chain of survival, its related exploration, management, and technical skills, and how Virtual Reality (VR) can be used for the creation of immersive environments capable of evaluating students' performance while applying the correct protocols. In particular, the Cardiopulmonary Resuscitation (CPR) procedure is studied as an essential step in the development of the chain of survival. The paper also aims to highlight the limitations of traditional methods using mechanical mannequins and the benefits of the new approaches that involve the students in virtual, immersive, and dynamic environments. Furthermore, an immersive VR station is presented as a new technique for assessing CPR performance through objective data collection and posterior evaluation. A usability test was carried out with 33 clinicians and OSCE evaluators to test the viability of the presented scenario, reproducing conditions of a real examination. Results suggest that the environment is intuitive, quick, and easy to learn and could be used in clinical practice to improve CPR performance and OSCE evaluation. [ABSTRACT FROM AUTHOR]

Background COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. Methods a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. Findings results are presented around three main themes: understanding, communication and impact. Participants' understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals' communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact—relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. Conclusion the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making. [ABSTRACT FROM AUTHOR]

Much of the law enforcement work takes place close to the public, often arriving at the scene before medical services in the case of victims of out-of-hospital cardiac arrest. If properly trained, these early care procedures can be powerful mechanisms to improve survival. This paper describes a case of out-of-hospital cardiac arrest assisted by law enforcement officers on the public highway in Asturias-Spain. In addition, a qualitative study was carried out to learn about the experience of the officers during the intervention, their willingness to act in similar emergencies, as well as to gather information about their training and knowledge of basic life support. The case was successfully resolved; however, some errors in the spontaneous execution of the chain of survival and the officers' statements prompted some recommendations for the mobilization, training and staffing of law enforcement agencies in Spain. [ABSTRACT FROM AUTHOR]

Conflict between nations harms not only its direct victims, but often the next generations. History teaches us that concord and international cooperation favors the progress of science, especially medicine, while wars and violence provoked by different religious, ideological, political, and sociocultural contexts hinder scientific research to the detriment of humanity. The objective of this article is to recall some notable figures in the history of cardiopulmonary resuscitation (CPR), focusing on the negative consequences of ideological persecution for the science of CPR. (CPR) is rooted in fundamental concepts of human anatomy and physiology that, while first described more than 500 years ago, only came to light centuries later due to the complex ideological situation of the epoch. While CPR in its current form is a relatively modern discipline, dating from the 1950s, we can postulate that the lack of international cooperation and the prevalence of totalitarian ideologies which characterized the 20th century constituted an obstacle for the free development and divulgation of this life-saving technique. This paper aims to describe and analyze some of the most representative figures from the history of CPR whose contributions to science had to overcome different political, ideological, and sociocultural barriers, standing today as a monument to mankind's tenacity in the search for knowledge. [ABSTRACT FROM AUTHOR]

Background: This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021.Methods: Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes.Results: 98 papers were selected for brief mention.Conclusions: Resuscitation science continues to evolve and incorporates all links in the chain of survival. [ABSTRACT FROM AUTHOR]

Background: Alongside medical science, educational efficiency and local implementation have been identified as the three leading themes that influence cardiac arrest survival outcomes. Where the medical science domain continues to inform the contemporary evidence for the optimal practice, the remaining two education themes continue to face criticism linked to the poor sustainability of clinician resuscitation skills, with a rapid decay in abilities often evident soon after training and certification. The European Resuscitation Council recently reasserted the importance of programmes to reflect educational best practices and learning theory. Discussion: This paper discusses a selection of key contemporary theoretical themes, which directly relate to several specific ongoing education concerns. Reccomendations: Beyond questioning the effectiveness of current conventions to achieve sustainable knowledge and skills for the long term, it is suggested that common approaches may not be sufficient to prepare clinicians or certify competency for the complexities of these future events and that a major pedagogical shift may be required to teaching and assessment. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation (CPR) is a life-saving procedure that can multiply a person's chances of survival after a cardiac arrest. The effectiveness of CPR procedures is heavily influenced by the individual skills of the rescuer providing assistance. Chest compressions delivered at an appropriate depth and rate, allowing full chest recoil and with minimal interruptions, are critical for improving cardiac arrest survival. The lack of quality CPR training models in developing countries has a significant impact on the quality of CPR training and skills acquired. Therefore, in this paper, we aim at improving CPR training by designing a high-fidelity CPR training manikin. The model includes a feedback mechanism for monitoring CPR performance status to allow for effective practice and rehearsal until required CPR skills are acquired. An in-depth study of existing training systems was conducted to ensure the proper design of the proposed system. The test results show that the designed manikin prototype analyses the quality of CPR performance and provides appropriate feedback to the trainee. The model can be used for training medical students and other practitioners to correctly perform CPR. [ABSTRACT FROM AUTHOR]

Objective: To investigate demographics, clinical patterns and outcomes of rapid response reviews in hospital, reviewing indications for and outcomes of rapid response reviews initiated for clinical concern and to understand the role of clinical concern in identifying the deteriorating patient and at-risk patient populations. Method: This was a retrospective analysis of General Medical inpatients at Alfred Hospital from 1 January 2018 to 31 July 2020. Data extraction from electronic medical records identified patients who had a rapid response review during admission. Demographic and clinical data, investigations and clinical outcomes from rapid response reviews were investigated. Comparisons were performed using χ 2 or Fisher's exact test where appropriate. Odds ratios and 95% confidence intervals were calculated for factors associated with rapid response reviews for clinical concern and clinical outcomes. Results: There were 10 797 admissions of 7409 individual patients. There were 2359 rapid response reviews during the study period, occurring in 13% of admissions. Patients were majority female (50.4%), and the median age was 79 ± 17.6 years. Rapid response reviews were for cardiovascular (46.8%), respiratory (25.3%) and neurological (14.3%) indications. A total of 11% of rapid response reviews (n = 258) were for clinical concern. Inpatient falls accounted for a significant proportion of rapid response reviews for clinical concern. Reviews were more common in older patients, those admitted after-hours, and patients with disabilities. The latter group were more likely to have rapid response reviews for clinical concern. Rapid response reviews initiated for clinical concern were more likely than those initiated for standard criteria to change patients' clinical status, particularly the withdrawal of active management. Conclusions: Rapid response reviews for clinical concern are important triggers to identify clinical deterioration in vulnerable patients. Reviews were initiated for clinical concern were more likely than those initiated for standard criteria to result in a change in patients' resuscitation status and care trajectory. Clinician concern, even when prompting review for parameters outside of standard clinical review criteria, remains an important factor in recognising the deteriorating patient. What is known about the topic? Rapid response reviews, including those initiated for clinician gestalt for clinical concern, are important tools to identify deteriorating patients in the inpatient setting. What does this paper add? Rapid response reviews for clinical concern are of particular relevance in vulnerable populations and may be important in identifying deteriorating patients and reassessing care trajectory. What are the implications for practitioners? Clinical concern may be just as clinically relevant as rapid response reviews prompted by standard criteria, especially in vulnerable populations. This might prompt investigation of better identifiers and tools for escalation of concerns for vulnerable patients, which may improve outcomes in this patient group. [ABSTRACT FROM AUTHOR]

Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real‐world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real‐world emergencies. A quasi‐experiment was conducted to assess the effectiveness of the IVR‐based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two‐minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self‐efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five‐week follow‐up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems. Practitioner notesWhat is already known about this topic Many trainees who have received traditional cardiopulmonary resuscitation (CPR) training hesitate to perform the skills learned in a real‐world emergency.The critical determinant of whether an individual performs a behaviour is the individual's 'intention' to perform that behaviour.Individual's self‐efficacy to perform CPR, attitudes towards CPR, and perceived social norms are three determinants that influence intention to perform CPR.Immersive media such as virtual reality may elicit more attitudinal changes and a greater sense of learner self‐efficacy than current mainstream media.What this paper adds The study's results indicated that compared to conventional technology‐supported video training, immersive virtual reality (IVR) training significantly increased participants' self‐efficacy about performing CPR, positive attitudes towards CPR and CPR knowledge.CPR training through IVR may enhance trainees' intention to perform CPR in real‐world emergencies.Implications for practice and/or policy The effectiveness of combining IVR technology into existing CPR training methods such as mixed reality training, which blends virtual environments with realistic mannequins, should be further examined in the future.IVR may be a more effective medium for enhancing the intention to perform behaviour than conventional technology. Future research could further experiment with the use of IVR as a behavioural intervention technique in education [ABSTRACT FROM AUTHOR]

The objective of this paper is to review common challenges when evaluating fractures in the setting of possible child abuse and approaches to navigate them. This paper reviews the variety of imaging modalities available for evaluating child abuse and the advantages/disadvantages of each. Additionally, the authors discuss management of equivocal fractures, including the impact of double-reading skeletal surveys. The complexity of dating the acuity of fractures in young children is discussed. Utilizing the knowledge of fracture type, fracture patterns and patient history, as well as in the setting of cardiopulmonary resuscitation, the authors provide methods for determining the likelihood of abuse. [ABSTRACT FROM AUTHOR]

Background: This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2020. The number of papers submitted to the Journal in 2020 increased by 25% on the previous year.MethodsHand-searching by the editors of all papers published in Resuscitation during 2020. Papers were selected based on then general interest and novelty and were categorised into general themes.ResultsA total of 103 papers were selected for brief mention in this review.ConclusionsResuscitation science continues to evolve rapidly and incorporate all links in the chain of survival. [ABSTRACT FROM AUTHOR]

Background: The ILCOR Basic Life Support Task Force and the international drowning research community considered it timely to undertake a scoping review of the literature to identify evidence relating to the initial resuscitation, hospital-based interventions and criteria for safe discharge related to drowning.Methods: Medline, PreMedline, Embase, Cochrane Reviews and Cochrane CENTRAL were searched from 2000 to June 2020 to identify relevant literature. Titles and abstracts and if necessary full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on the population (adults and children who are submerged in water), interventions (resuscitation in water/boats, airway management, oxygen administration, AED use, bystander CPR, ventilation strategies, ECMO, protocols for hospital discharge (I), comparator (standard care) and outcomes (O) survival, survival with a favourable neurological outcome, CPR quality, physiological end-points).Results: The database search yielded 3242 references (Medline 1104, Pre-Medline 202, Embase 1722, Cochrane reviews 12, Cochrane CENTRAL 202). After removal of duplicates 2377 papers were left for screening titles and abstracts. In total 65 unique papers were included. The evidence identified was from predominantly high-income countries and lacked consistency in the populations, interventions and outcomes reported. Clinical studies were exclusively observational in nature.Conclusion: This scoping review found that there is very limited evidence from observational studies to inform evidence based clinical practice guidelines for drowning. The review highlights an urgent need for high quality research in drowning. [ABSTRACT FROM AUTHOR]

Context: In medical education, there are often several didactic methods for teaching and learning a specific medical skill. For educators, there are often pragmatic reasons to decide for one or another of them, such as costs, infrastructural requirements, time expenditure or qualification of the teacher. However, a central aspect to consider is the learning outcome: Does a new method achieve a similar learning success as an established standard method? To answer this question, we need an appropriate method to assess comparability of learning outcomes. Methods: In this paper, we present two essential statistical concepts that can address the issue of comparability of learning outcomes: Equivalence and non‐inferiority testing. We explain the ideas behind these concepts and illustrate them with an example data set. To clarify several concepts, we use theoretical examples from one selected field: the teaching and assessment of Basic Life Support (BLS). Conclusions: Equivalence and non‐inferiority tests can be powerful tools for comparing teaching and assessment methods. However, their correct application requires adequate knowledge about their strengths, pitfalls and application fields. The aim of this paper is to deliver this knowledge and to provide clinician researchers with a practical guidance to a successful application of these methods. In the latest addition to the Research Approaches section, Klasen and Sopka discuss the concepts of equivalence and non‐inferiority studies while highlighting the benefits and pitfalls of their application. [ABSTRACT FROM AUTHOR]

Background: Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand. Methods: This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital's emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected. Results: A total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period). Conclusions: During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups. Trial registration: This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to determine the association of cardiopulmonary resuscitation (CPR) for in hospital cardiac arrest (IHCA) with quality of life after discharge.Methods: We performed a systematic review using available databases for studies that measured any quality-of-life or functional outcome both before and after CPR for IHCA. All screening and data abstraction was performed in duplicate.Results: We screened 10,927 records and included 24 papers representing 20 unique studies. Fifteen studies measured Cerebral Performance Category. Survival ranged from 11.8% to 39.5%. The risk of impaired cerebral function after discharged ranged from -16.1% (lower risk) to 44.7% increased risk of poor cerebral function after surviving to discharge. Four studies measured discharge to an institutional environment finding that the risk was increased by 18.2-72.2% among survivors. One study measured EQ-5D and found no difference pre and post CPR. One study measured performance of activities of daily living finding that survivors needed assistance with more activities after discharge.Conclusion: Our review is limited by the lack of adjustment for confounders, including the baseline level of each outcome, in all included studies. Therefore, although risk for most outcomes was increased after discharge vs pre-admission we cannot be certain if this is a causal relationship. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to discuss the implications of government responses to COVID-19 for older people. Governments in England and in Wales faced complex decisions when responding to COVID-19. This paper considers the impact of their actions on the human rights of older people. It argues that there is a case to answer of potential breaches of the European Convention on Human Rights. Although it is too early to come to firm conclusions as more scientific and medical evidence is required, some actions by governments seem to be based on using age as a basis for decision-making. Human rights are complex, and it is important that claims of violations satisfy the Convention, the Human Rights Act 1998, the jurisprudence of the European Court of Human Rights and other international instruments. Design/methodology/approach: The paper considers the legal framework of the European Convention and its relevance to Corona Virus Disease (COVID-19) and older people. Case law, academic research, guidance and media coverage form the basis of the research. Findings: The governments have a strong case to answer. In defending their positions against allegations of discrimination against older people, they need to produce strong and convincing evidence including medical and scientific evidence that formed the basis of their decisions. Originality/value: This paper is based on original research into human rights, older people and COVID-19. [ABSTRACT FROM AUTHOR]

The frequency of drowning increases with the warming of the weather, especially in the summer months. In this paper, the clinical features, radiological imaging and laboratory values of three patients who presented to the emergency department due to near-drowning are discussed comparatively. In Case 1 and 3, advanced life support was applied at the scene and spontaneous circulation was restored. Case 2 presented with the complaint of dyspnea. Cases 1 and 3 died after being admitted to the intensive care unit, while Case 2 was discharged with full recovery. Cardiopulmonary resuscitation performed at the scene is a sign of poor outcome. Diffuse ground-glass opacities were detected in the early thorax computed tomography imaging of all three cases. In addition, there were early increases in laboratory values in all three cases, with the highest increases being observed in aspartate aminotransferase, alanine aminotransferase and creatinine kinase values. This suggests that tissue perfusion disorder develops in the early period. [ABSTRACT FROM AUTHOR]

Introduction: Providing cardiopulmonary resuscitation (CPR) to a coronavirus disease-2019 (COVID-19) patient is challenging for the healthcare providers (HCP). COVID-19 cases have specific CPR requirements, which differ from standard resuscitation efforts. Objective: This paper aims to evaluate whether online learning can be an effective methodology for imparting information on the management of cardiopulmonary arrest in COVID-19 patients due to a novel virus unknown to HCP based on evaluation of knowledge acquisition and satisfaction of the nurses in the new area of medicine and virology. Methodology: In a single-arm, one group before and after design, from a cohort of 160 nurses trained in comprehensive cardiac life support (CCLS) formulated by the Indian Resuscitation Council (IRC), 73 nurses participated in the study. After obtaining informed consent through the email from the nurses, baseline data including demographic profile and knowledge related to CPR in COVID-19 patients were collected. An online intervention spread over 1 week was given using a validated e-learning module. The online intervention was found to be effective (pre- and post-intervention knowledge score 13.65 ± 3.01 vs 19.92 ± 1.94, p = 0.001). The majority of nurses were highly satisfied with the content and the training methodology (37.23 ± 4.70). Conclusion: A well-structured, online study material can be used in imparting knowledge and demonstrating the basic and essential skills to nurses, required for giving CPR to COVID-19 patients. [ABSTRACT FROM AUTHOR]

To describe the experience of professors and students on nursing protocols in the cardiac arrest of patients with COVID-19. This is a bibliographical research, with a qualitative approach and experience report between teacher and student, through the communication networks involving the use of remote technologies. The databases of the Brazilian Ministry of Health, Virtual Health Library (VHL), MEDLINE, IBECS and LILACS, were used. Data were collected from scientific papers published between July 2015 and July 2020. The workload of the nursing staff is a conditioning factor for mental and physical illness; fear of the pandemic; there are gaps in care delivery and training addressing cardiac arrest. The pandemic context revealed the essential role nurses play in care delivery and the urgency of basic and advanced life support training to improve safety, mitigate fears and prepare nursing workers to provide care in emergencies resulting from SARS-CoV-2. [ABSTRACT FROM AUTHOR]

This paper examines several decision-making models that have been proposed to limit the use of CPR for COVID-19 patients. My main concern will be to assess proposals for the implementation of unilateral DNRs — i.e., orders to withhold CPR without the agreement of patients or their surrogates. [ABSTRACT FROM AUTHOR]

As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-ofhospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation. [ABSTRACT FROM AUTHOR]

Circulatory arrest is an extremely serious condition in which only a rapid and well-performed intervention of other persons can save a life. The procedures used to restore blood flow in cardiac arrest are referred to as cardiopulmonary resuscitation and include organizational measures, device or mechanical therapy as well as administration of selected drugs – pharmacotherapy. The present paper presents an overview of the basic medications used in cardiopulmonary resuscitation, and briefly describes the mechanisms of their action, evidence of their effect, and guidelines for their use. [ABSTRACT FROM AUTHOR]

Aim: Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.Methods: A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.Results: 9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI -£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.Conclusion: The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA. [ABSTRACT FROM AUTHOR]

• Our paper reports four cases of uncommon cardiac rupture with intact pericardium. • Our paper proposes some diagnostic pointers to analyze the natural of this uncommon lesion. • We highlight that this lesion should be discriminated in CPR-related cardiac rupture. Cardiac rupture with intact pericardium is a dangerous lesion due to high and rapid mortality. Its most common etiologies are blunt chest trauma and myocardial infarction. In forensic practice, this type of rupture can involve a complex relationship between trauma and cardiac disease, so clarifying the main cause of rupture is critical. Herein, we present four cases of cardiac rupture with intact pericardium, which were due to trauma, pathology or both. We propose several diagnostic pointers to analyze this uncommon lesion. Furthermore, the possibility of cardiac rupture induced by cardiopulmonary resuscitation should also be discriminated in such cases. [ABSTRACT FROM AUTHOR]

Aims and objectives: The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. Background: Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. Design: Concept analysis. Methods: Walker and Avant's eight‐step approach to concept analysis. Results: The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. Conclusion: Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. Relevance to clinical practice: A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development. [ABSTRACT FROM AUTHOR]

The paper summarizes new guidelines or changes in the algorithms of basic and advanced life support, in the treatment of special conditions and the treatment of the child immediately after the return of spontaneous circulation. The basic feature of these changes, which were prepared in autumn 2020 and published in spring 2021, is that the algorithm of basic laife support is no longer uniform. There is an algorithm for lay persons and another algorithm for competent (healthcare professionals and first responders). However, the algorithms for advanced life support are increasingly specific and adapted to individual etiological entities. The changes in the instructions that are most important for the successful implementation of cardiopulmonary resuscitation are discussed. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. People in extremes of age and those having pre-existing disease are more prone to the infection. Transmission is by droplet/contact route or by airborne transmission in special circumstances i.e endotracheal intubation, bronchoscopy, tracheostomy, cardiopulmonary resuscitation etc. Not only the treatment of living infected subjects, handling of COVID-19 dead bodies is also having utmost importance to prevent the transmission of deadly virus to the body handlers (hospital staff/cremation staff/family members) in the hospital or at the cremation/burial site. Here in this review paper, we have discussed about the pros and cons of the cremation and burial of the body keeping in mind that no further spread of the virus could occur to the community. However for eg China and Sri Lankan authorities made cremation compulsory by official order while WHO, India and many other did not objected to either of them. In our opinion, cremation should be preferred for complete elimination of chances of infection. However keeping in mind the religious views of the family, if the burial of the body is requested, then it should be assured that the body is buried in a thick, air tight coffin and placed at normal depth of about 2 meter. It is recommended that the area above and adjacent to the grave should be cemented immediately as an additional precautionary to avoid scavenging by animal. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation (CPR) is a lifesaving emergency procedure. To increase survival rates, it is recommended to increase the number of high school students who know how to perform CPR. We have developed an immersive "Virtual Reality (VR) Resuscitation Training" to train the theoretical knowledge of CPR in which trainees must save the life of the patient in a virtual environment. This paper presents a randomized controlled study with a pre‐posttest design to explore whether a VR enhanced curriculum improves high school students' theoretical CPR knowledge. Forty students without previous CPR experience in the past year were randomly assigned to either the VR group or the standard group. The VR group had a significant higher increase of correct answers in comparison with the Standard group. More importantly, the gain in score on taking the correct sequence of CPR steps was significant favouring the VR‐enhanced protocol over the Standard protocol. Therefore, the use of a VR training for CPR training appears to be an effective learning method for non‐medical students and may be of great value skilling high school students in becoming adequate CPR providers. [ABSTRACT FROM AUTHOR]

Aim: The AIRWAYS-2 cluster randomised controlled trial compared the i-gel supraglottic airway device (SGA) with tracheal intubation (TI) as the first advanced airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months.Methods: Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods.Results: 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69-1.14; 6 months OR 0.91, 95% CI 0.71-1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings.Conclusion: There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months. [ABSTRACT FROM AUTHOR]

Aim: To determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery.Methods: We searched Medline, Cochrane Library and Web of Science for studies published since 2009 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and quality of CPR. We included randomised controlled trials only. We identified pre-2010 studies from the 2010 ILCOR evaluation of this topic. Two reviewers independently screened titles/ abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model.Results: Database searches identified 2701 citations. We included seven studies published since 2009. We analysed these studies together with the four studies included in the previous ILCOR review. All included studies were randomised controlled trials in manikins. Certainty of evidence was very low. Increasing mattress stiffness or moving the manikin from the bed to the floor did not improve compression depth. Use of a backboard marginally improved compression depth (mean difference 3 mm (95% CI 1-4).Conclusion: The use of a backboard led to a small increase in chest compression depth in manikin trials. Different mattress types or delivery of CPR on the floor did not affect chest compression depth. PROSPERO CRD42019154791. [ABSTRACT FROM AUTHOR]

The aim of this paper is to report the findings of the consultation rounds with former patients and health care professionals to inform the design of a qualitative study. We aimed to understand stakeholders' views regarding the relevance of a proposed study looking at the impact of patients witnessing cardiopulmonary resuscitation on other patients in hospital, the appropriateness of the proposed methodology and ethical aspects. We conducted an online survey (n = 22) and telephone interviews (n = 4) with former patients linked to the British Heart Foundation charity and a focus group (n = 15) with hospital health care professionals involved in cardiopulmonary resuscitation activities. Data were analysed using thematic analysis. The consultation rounds provided valuable advice on three major themes: conceptual aspects, methodological aspects and practical suggestions. The conceptual aspects were related to the relevance of the proposed study, the emotional impact for participating patients and how the social interaction among patients could influence the witnessing experience. Methodological advice included recruitment strategies and data collection methods such as the use of individual and focus group interviews, the timeframe of interviews with patients and the topics of the interview guides. In the third theme, practical suggestions were provided, such as strategies to advertise the study, improving the public's and participants' engagement throughout the study process and disseminating the findings. Overall, the study proposed in this consultation was considered relevant and worthy by patients and health care professionals to raise awareness and generate new evidence on an unconsidered aspect of cardiopulmonary resuscitation and of patients' hospital experience. These stakeholders' consultation rounds constituted a valuable exercise to design high‐quality research based on a shared vision among researchers, service users and clinicians. They also provided pragmatic advice to inform critical care practice to support patients witnessing cardiopulmonary resuscitation in hospital. [ABSTRACT FROM AUTHOR]

During the current COVID-19 global pandemic, the major efforts are channeled toward containing and minimizing the spread and maintaining the healthcare providers' safety. One of the major aspects of effective infection control and prevention is healthcare team training and system troubleshooting. Simulation-based education appears to be a practical and flexible instructional design to achieve variable levels of knowledge, skills, and attitude training. In this paper, we aim is to provide a brief scheme on how simulation-based training can be employed in COVID-19 pandemic preparedness efforts. In addition, we will be sharing our multidisciplinary simulation experience in critical care at the National Guard Health Affairs, Saudi Arabia. [ABSTRACT FROM AUTHOR]