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A heart attack is the sudden cessation of effective heart function in a healthy-looking individual. Basic Life Support training becomes an important thing for the layman considering the many incidents of cardiac arrest outside the hospital that need a lot of time to get the help of trained health workers. The purpose of this social service is to increase knowledge and skills in the field of Basic Life Support, participants are able to practice handling code blue in accordance with the procedures and the flow of fast and precise. Specific targets to be achieved are the formation of Code Blue System at Pondok Pesantren Putra and the formation of BLS Citizen Community in Kediri. The method used in community service is by In-house training supported by lecture, demonstration and practice methods. The targets of this activity are the students who include 38 students who are given Basic Life Support training for one day, then compared the level of knowledge and attitude before and after (pre post-test design). Different test results of attitude before and after training is not different meaningful. However, it does not mean that the training process can be considered unsuccessful in improving the attitude of all participants, because the average attitudes value is still high, more than 4. This is presumably still good attitude retention from Basic Life Support training which has been given in the same population a year ago. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest is a common health issue in modern days and one of the emerging health issues in present days. One-third of client required cardiopulmonary resuscitation (CPR) before reaching to the hospital. Therefore some countries have been implanted Basic life support t raining compulsory for teachers and students. Material And Methods: A quantitative cross-sectional pilot study was conducted among school teachers. A total of 22 participants were selected using a non-probability purposive sampling technique. An evaluated the effectiveness of basic life support (BLS) among school teachers on Knowledge, attitude, and practice. The pre-test was assessed before the intervention and the post-test assessment was assessed at the end of 5th day. Result: On assessment, the majority of participants was male (72.7%), married 16(72.7%), and aged between 20 and 30 years old 10 (45.5%). Of the 14.3% of graduates, teaching experience varied from 6 to 10 years 16 (72.7%), and the majority of them were science teachers 17 (68.2%). The majority of teachers, 17 (68.2%) were Hindu don't have previous knowledge of 17(77.3%). There was a correlation between knowledge score and gender, experience, designation, and prior knowledge. Before the intervention of basic life support training, the majori ty of participants had poor knowledge12 (56.6%), post-test improved good knowledge 20(90.9%). Similarly, in the pretest, most of the participants had a negative attitude 16(72.7%), and a few after BLS showed a positive attitude 20(90.9%). Pretest practice skills had inadequate 17 (77.3%), moderate knowledge 5(22.7%), after the intervention, most of them 20(90.9%) had good knowledge. Conclusion: Basic life support (BLS) is the most effective intervention for school teachers. Most of the school teachers improved the knowledge, attitude and practice after the intervention. [ABSTRACT FROM AUTHOR]

Objective: Professional training workshops are routinely conducted by Professional Development Center (PDC) of DUHS to provide students golden opportunities in hands on practice on simulators and also has been working as training center of AHA since 2010 for the BLS, ACLS and PALS provider and instructor courses while has been conducting BLS workshops from Nov, 2005. The objective of this study was to assess the perceptions of attending audience by post course evaluation form in BLS program. Methodology: This was a retrospective survey study. Data of BLS workshops from 2017 to 2018 was collected from PDC. Two thousand and fifty six healthcare students were enrolled in BLS course from Jan 2017 till Dec 2018. The calculated sample size was about 324 at 95% confidence level. Thus the final sample size was about 350. A post workshop evaluation questionnaire was used as a tool for data collection and it was analyzed on SPSS. Results: PDC has conducted 714 BLS provider courses since 2005 in which 8529 participants are trained till now. The results of the evaluation show that this workshop received higher score on all assessed sections i.e. more than 90% candidates marked agree & strongly agree. A clear majority of participants (97.8%) agreed that, their queries and questions were satisfactorily responded The structure and content of the workshop organized intensify participants’ skills and knowledge regarding BLS. Conclusion: Overall, Participants characterized the workshop as very useful and were very satisfied with the workshop facilitators and the topics discussed. [ABSTRACT FROM AUTHOR]

Background: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. Aims: The purpose of this study was to assess healthcare professionals' knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. Methods and results: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support (P =0.005) while Belgium hospitals scored highest on advanced life support (P <0.001) and total score in cardiopulmonary resuscitation knowledge (P =0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training (P <0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P <0.001). Conclusion: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients' return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization's endorsement of the "Kids save lives" statement fosters the implementation of cardiopulmonary resuscitation (CPR) training for school children worldwide. However, not every child achieves and maintains the recommended chest compression depth of 5-6cm.Purpose: To investigate the variability in compression depth for three age groups (grade 1: 12-14; grade 2: 14-16; grade 3: 16-18 years) as a function of physical characteristics and to define minimal compression excellence levels for training.Methods: Compression depth of 265 subjects (111 girls, 154 boys) aged 12-18 years from one secondary school was individually assessed and reported in percentiles per age group. Pearson correlations between physical characteristics and CPR variables were calculated. Excellence level was defined as the percentage compressions with depth 5-6cm.Results: In grade 1 (12-14 years), achieved excellence levels were 1% for girls and 23% for boys at the 75th percentile. In grade 2 (14-16 years), it increased to 24% for girls and 80% for boys. In grade 3 (16-18 years) finally, it was 59% for girls and 87% for boys. Significant positive correlations were found between CPR and physical variables (p<0.05), especially weight >50kg (p<0.01).Conclusion: A minimal excellence level of 25% is achievable by boys 12-14year and girls 14-16year and can be gradually improved to 60% and 90% according to age and gender. This might necessitate more exertion and training for some younger children, especially girls, and will probably be more easily achieved for children weighing >50kg. [ABSTRACT FROM AUTHOR]

Introduction: The Knowledge of Basic Life Support (BLS) is very important, especially for medical students who will become future doctors. These simple life saving maneuvers can ensure the patient's survival and reduce morbidity and mortality. Objective: The objective of this study was to determine the level of knowledge, attitude and practice of BLS among medical students of the Rawalpindi Medical University, Rawalpindi. Methods: In this descriptive cross sectional study, medical students (3rd & 4th year MBBS) of RMU (n=376) were inquired using a self-structured questionnaire of 20 questions regarding the knowledge, attitude and practice of BLS. After excluding the incomplete response forms, the data were analyzed using SPSS v. 22.0. Results: Twenty five percent students had good, 65.7% had average and 9.3% had poor knowledge of BLS. Out of 376, 12.76% respondents were satisfied with their present knowledge. The Majority (93.08%) had a positive attitude towards learning BLS. Only 6.6% had practiced BLS and 65.69% were unable to perform CPR independently. Conclusion: Majority had an average knowledge and a positive attitude towards BLS but very few could perform it independently. This demands that the practice should go hand in hand along with its knowledge. [ABSTRACT FROM AUTHOR]

Aims: Feedback is vital for the effective delivery of skills-based education. We sought to compare the sandwich technique and learning conversation structured methods of feedback delivery in competency-based basic life support (BLS) training.Methods: Open randomised crossover study undertaken between October 2014 and March 2015 at the University of Birmingham, United Kingdom. Six-hundred and forty healthcare students undertaking a European Resuscitation Council (ERC) BLS course were enrolled, each of whom was randomised to receive teaching using either the sandwich technique or the learning conversation. Fifty-eight instructors were randomised to initially teach using either the learning conversation or sandwich technique, prior to crossing-over and teaching with the alternative technique after a pre-defined time period. Outcome measures included skill acquisition as measured by an end-of-course competency assessment, instructors' perception of teaching with each feedback technique and candidates' perception of the feedback they were provided with.Results: Scores assigned to use of the learning conversation by instructors were significantly more favourable than for the sandwich technique across all but two assessed domains relating to instructor perception of the feedback technique, including all skills-based domains. No difference was seen in either assessment pass rates (80.9% sandwich technique vs. 77.2% learning conversation; OR 1.2, 95% CI 0.85-1.84; p=0.29) or any domain relating to candidates' perception of their teaching technique.Conclusions& Relevance: This is the first direct comparison of two feedback techniques in clinical medical education using both quantitative and qualitative methodology. The learning conversation is preferred by instructors providing competency-based life support training and is perceived to favour skills acquisition. [ABSTRACT FROM AUTHOR]

Aim Assessment skills are often neglected in resuscitation training and it has been shown that the ERC BLS/AED instructor course may be insufficient to prepare candidates for an assessment role. We have introduced an Assessment Training Programme (ATP) to improve assessors’ decision making. In this article we present our ATP and an observational study of candidates’ confidence levels upon completing both an ERC BLS/AED instructor course and our ATP. Methods Forty-seven candidates undertook the ERC instructor course and 20 qualified ERC BLS/AED instructors undertook the ATP. Pre- and post-course questionnaires were completed. Confidence was assessed on ten-point Visual Analogue Scales (VAS). Results Overall confidence on the ERC BLS/AED instructor course rose from 5.9 (SD 1.8) to 8.7 (SD 1.4) ( P < 0.001). A more modest improvement was witnessed on the ATP, rising from 8.2 (SD 1.4) to 9.6 (SD 0.5) ( P < 0.001). Upon completion of their respective courses, assessors (mean 9.6, SD 0.5) were significantly more confident at assessing than instructors (mean 8.7, SD 0.5) ( P < 0.001). Confidence in assessing individual algorithm components was similar on both courses. On the post-course questionnaire those on the ATP remained significantly more confident at assessing borderline candidates compared to instructors ( P < 0.001), with no difference for clear pass ( P = 0.067) or clear fail ( P = 0.060) candidates. Conclusion The ATP raises the confidence of assessing BLS/AED candidates to a level above that of the ERC instructor course alone. We advocate that resuscitation organisations consider integrating an ATP into their existing training structure. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the long-term effectiveness of 15-min refresher basic life support (BLS) training following 45-min chest compression-only BLS training. Methods After the 45-min chest compression-only BLS training, the participants were randomly assigned to either the refresher BLS training group, which received a 15-min refresher training 6 months after the initial training (refresher training group), or to the control group, which did not receive refresher training. Participants’ resuscitation skills were evaluated by a 2-min case-based scenario test 1 year after the initial training. The primary outcome measure was the number of appropriate chest compressions during a 2-min test period. Results 140 participants were enrolled and 112 of them completed this study. The number of appropriate chest compressions performed during the 2-min test period was significantly greater in the refresher training group (68.9 ± 72.3) than in the control group (36.3 ± 50.8, p = 0.009). Time without chest compressions was significantly shorter in the refresher training group (16.1 ± 2.1 s versus 26.9 ± 3.7 s, p < 0.001). There were no significant differences in time to chest compression (29.6 ± 16.7 s versus 34.4 ± 17.8 s, p = 0.172) and AED use between the groups. Conclusions A short-time refresher BLS training program 6 months after the initial training can help trainees retain chest compression skills for up to 1 year. Repeated BLS training, even if very short, would be adopted to keep acquired CPR quality optimal (UMIN-CTR UMIN 000004101). [ABSTRACT FROM AUTHOR]

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students' knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS). Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test. Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts. Conclusion: There is a significant difference in medical students' knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Previous studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e. “Milestones”. We developed a simulation-based teaching approach “Rapid Cycle Deliberate Practice” (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e. “first-five minutes” (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to “try again” over lengthy debriefing. Participants: Pediatric residents from an academic medical center. Methods: Prospective pre-post interventional study of residents managing a simulated cardiopulmonary arrest. Main outcome measures include: (1) interval between onset of pulseless ventricular tachycardia to initiation of compressions and (2) defibrillation. Results: Seventy pediatric residents participated in the pre-intervention and fifty-one in the post-intervention period. Baseline characteristics were similar. The RCDP-FFM intervention was associated with a decrease in: no-flow fraction: [pre: 74% (5–100%) vs. post: 34% (26–53%); p <0.001)], no-blow fraction: [pre: 39% (22–64%) median (IQR) vs. post: 30% (22–41%); p =0.01], and pre-shock pause: [pre: 84s (26–162) vs. post: 8s (4–18); p <0.001]. Survival analysis revealed RCDP-FFM was associated with starting compressions within 1min of loss of pulse: [Adjusted Hazard Ratio (HR): 3.8 (95% CI: 2.0–7.2)] and defibrillating within 2min: [HR: 1.7 (95% CI: 1.03–2.65)]. Third year residents were significantly more likely than first years to defibrillate within 2min: [HR: 2.8 (95% CI: 1.5–5.1)]. Conclusions: Implementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency. [Copyright &y& Elsevier]

Background: The knowledge and skills about the basic life support (BLS) and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups), course of study (nursing, dental, and medical groups), and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Results: Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10). Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05). Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05). About 322 (61.9%) subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1%) responded that BLS training should be a part of medical curriculum. Conclusion: Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution. [ABSTRACT FROM AUTHOR]

Introduction: Basic life support (BLS) with cardiopulmonary resuscitation (CPR) provided at the right time greatly improves survival following cardiac arrest. Adequate knowledge and skills related to BLS are essential requisites for medical students. This study aimed to explore the knowledge, attitudes, and practices related to BLS among undergraduate medical students of a medical college in Tamil Nadu, India. Materials and Methods: This was a descriptive, cross-sectional study conducted among 241 undergraduate medical students of a medical college in Tamil Nadu, between May and July 2012, using a pretested, semi-structured questionnaire devised based on American Heart Association Guidelines for BLS and CPR 2010. Results: The mean knowledge score of the participants was 4.55 ± 1.21 out of a possible high score of 6. The level of knowledge and attitudes related to BLS varied depending on the year of study, and this difference was statistically significant (p<0.05). The knowledge score decreased with increasing duration of training. The higher the year of study, the more positive the participants' attitudes were. Only 12.9% of the participants had ever practised BLS. Twenty-one (21) participants (8.7%) expressed reluctance about performing BLS in a hospital setting, and 57.3% of the participants expressed reluctance about performing BLS in an out-of-hospital setting. Fear of acquiring infection, causing harm to the victim, and lack of confidence were the common causes for participants' reluctance. Conclusions: The study reveals inadequate knowledge and practices related to BLS among students. The differences in knowledge and attitudes among students, depending on the year of study, point to the need for frequent refresher training and motivation of students. [ABSTRACT FROM AUTHOR]

Background: Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers’ performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality. Methods: In this open, prospective, randomised, controlled trial we compared three CPR feedback devices (PocketCPR®, CPRmeter®, iPhone app PocketCPR®) with standard BLS without feedback in a simulated scenario. 240 trained medical students performed single rescuer BLS on a manikin for 8min. Effective compression (compressions with correct depth, pressure point and sufficient decompression) as well as compression rate, flow time fraction and ventilation parameters were compared between the four groups. Results: Study participants using the PocketCPR® performed 17±19% effective compressions compared to 32±28% with CPRmeter®, 25±27% with the iPhone app PocketCPR®, and 35±30% applying standard BLS (PocketCPR® vs. CPRmeter® p =0.007, PocketCPR® vs. standard BLS p =0.001, others: ns). PocketCPR® and CPRmeter® prevented a decline in effective compression over time, but overall performance in the PocketCPR® group was considerably inferior to standard BLS. Compression depth and rate were within the range recommended in the guidelines in all groups. Conclusion: While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome. [ABSTRACT FROM AUTHOR]

Abstract: Although fatal drowning rarely occurs in swimming pools, this event has a very grave impact on the swimming pool employees, notably when they have been directly involved in the rescue and resuscitation. At the same time, very little data is available on the incidence, causes and outcome of pool drowning. It is important that pool lifeguards understand that a cardiac arrest after drowning is different from the primary cardiac arrest due to an infarction or ventricular fibrillation and that oxygen is the most vital aspect of the resuscitation measures. The use of a pool safety plan and the implementation of a checklist, training in realistic pool-related resuscitation scenarios and record keeping of accidents and near-accidents may be helpful to be better prepared for a drowning incident. [Copyright &y& Elsevier]

Abstract: Aim: Existing ERC BLS/AED accreditation procedures allow BLS instructors to assess the capability of BLS/AED providers, without undergoing additional training as an assessor. The reliability of instructor-based assessment has been questioned. This study sought to determine the efficacy of a simple training programme for BLS/AED instructors aimed at standardising assessment decisions. Methods: An Assessment Training Programme (ATP) which provides additional, assessment-focused tuition for BLS instructors was introduced. Eighteen ERC accredited instructors participated in the study. Nine received standard ERC training (instructors); nine received additional training through the ATP (assessors). The assessment of 73 students’ BLS/AED capabilities was carried out by an assessor, ERC instructor and ERC instructor trainer concurrently. Participants independently completed an ERC assessment form. Decisions for instructors and assessors were compared to the instructor trainers’ decisions; those not agreeing were deemed to be incorrect. Results: Instructors (49.3%) had lower raw pass rates than assessors (67.1%) and instructor trainers (64.4%). There was a significant difference in overall decisions between instructors and instructor trainers (p =0.035), and instructors and assessors (p =0.015). There was no difference between assessors and instructor trainers (p =0.824). Instructors were more prone to incorrectly failing candidates than assessors (sensitivities of 80.5% and 63.8% respectively, p =0.077). AED-capability decisions were significantly different from instructor trainers in both the instructor (p =0.007) and assessor groups (p =0.031). Conclusion: BLS instructors incorrectly fail candidates for reasons that should not normally constitute a true assessment failure. The ATP is an effective intervention to reduce false-failure rates and improve compliance with an experienced instructor trainer''s decision. Consideration should be made to integrate such programmes into current BLS instructor accreditation procedures. [Copyright &y& Elsevier]

Abstract: Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. Objectives: To assess the performance of the BLS and ALS TOR in Japan. Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963–0.972), and the PPV was 0.998 (95% CI: 0.998–0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973–0.986), and the PPV was 0.999 (95% CI: 0.998–0.999) for predicting lack of neurologically favorable one-month survival. Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules. [Copyright &y& Elsevier]

Abstract: Aim: To compare the time-dependent changes in the quality of chest compressions in 30:2 cardiopulmonary resuscitation (CPR) and hands-only cardiopulmonary resuscitation (HO-CPR) and to evaluate how individual rescuer factors affect the quality of chest compressions over time for both CPR techniques. Methods: Total 1028 adult hospital and university workers participated in CPR training programs including sessions of 30:2 CPR and HO-CPR. Tests of both CPR methods were performed in a random order using a manikin with Skill-Reporter™. Data were collected from 863 subjects. The time-dependent changes in chest compressions quality and the effects of individual rescuer factors (age, gender, body mass index (BMI), prior CPR training and experience) were analysed using the general linear model for a repeated-measures procedure. Results: In HO-CPR, the mean proportion of correct compressions depth (MPCD) decreased significantly throughout the time sectors following 20–40s (74.4–50.4% in 100–120s) compared to 30:2 CPR (83.4–76.3% in 100–120s) (p <0.0001). A significant decline of MPCD (MPCD<70%) was initially observed at 40–60s in HO-CPR, however, this pattern was not observed in 30:2 CPR. Individual rescuer factors minimally affected the time-dependent change in MPCD during 30:2 CPR. For HO-CPR, all rescuer factors except for male or obese/overweight (BMI≥25) were associated with a significant declines of MPCD, and these decline were usually observed from 40 to 60s. Conclusion: Switching rescuers at an interval of 2-min is reasonable for 30:2 CPR. However, for HO-CPR switching rescuers every 1-min may be preferable except when rescuers are male or obese/overweight (BMI≥25). [Copyright &y& Elsevier]

Abstract: Background: Cardiopulmonary resuscitation (CPR) mastery continues to challenge medical professionals. The purpose of this study was to determine if an emotional stimulus in combination with peer or expert feedback during pre-course assessment effects future performance in a single rescuer simulated cardiac arrest. Methods: First-year medical students (n =218) without previous medical knowledge were randomly assigned to one of the study groups and asked to take part in a pre-course assessment: Group 1: after applying an emotionally activating stimulus an expert (instructor) gave feedback on CPR performance (Ex). Group 2: after applying the same stimulus feedback was provided by a peer from the same group (Pe); Group 3: standard without feedback (S). Following pre-course assessment, all subjects received a standardized BLS-course, were tested after 1week and 6months later using single-rescuer-scenario, and were surveyed using standardized questionnaires (6-point-likert-scales: 1=completely agree, 6=completely disagree). Results: Participants exposed to stimulus demonstrated superior performance concerning compression depth after 6months independent of feedback-method (Ex: 65.85% [p =0.0003]; Pe: 57.50% [p =0.0076] vs. 21.43%). The expert- more than the peer-group was emotionally more activated in initial testing, Ex: 3.26±1.35 [p ≤0.0001]; Pe: 3.73±1.53 [p =0.0319]; S: 4.25±1.37) and more inspired to think about CPR (Ex: 2.03±1.37 [p =0.0119]; Pe: 2.07±1.14 [p =0.0204]; S: 2.60±1.55). After 6months this activation effect was still detectable in the expert-group (p =0.0114). Conclusions: The emotional stimulus approach to BLS-training seems to impact the ability to provide adequate compression depth up to 6months after training. Furthermore, pre-course assessment helped to keep the participants involved beyond initial training. [Copyright &y& Elsevier]

Abstract: Aim of the study: The aim of this study was to study exercise-related cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation on survival rate and outcome. Methods: This study was based on the cardiac arrest registry of the Department of Emergency Medicine at the General Hospital Vienna in Austria. Between February 1993 and April 2010 non-professional athletes were identified, who experienced exercise-related cardiac arrest on the tennis court. The analysis was accomplished using descriptive statistics. Results are presented as mean±standard-deviation or median and interquartile range (IQR). Results: The subjects (n =27) were predominantly male (96%) with a median age of 58 years; 52% of all patients had underlying cardiovascular risk factors. All cardiac arrests were witnessed. Bystander CPR was documented in 17 cases (63%). Median time from collapse to initiation of CPR was 1(IQR 0–2) minute. Ventricular fibrillation was the initial rhythm in 25 patients (93%) and in 3 an automated external defibrillator was used by bystanders. Twenty-four patients (89%) had return of spontaneous circulation before admission to the hospital and four (15%) followed verbal commands thereafter. The survival rate at 6 months was 82% with 20 patients (74%) having favourable neurologic outcome. Conclusions: Cardiac arrest on the tennis court is a predominantly witnessed event with a respectively high rate of bystander CPR, which reflects in a high successful survival rate. [Copyright &y& Elsevier]

Abstract: Background: Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum. Methods: Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16–19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR. Results: Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training. Conclusion: Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA. [Copyright &y& Elsevier]

Background: External chest compressions (ECC) are essential components of resuscitation and are usually performed without any adjuncts in professional healthcare. Even for healthcare professionals during in-hospital and out-of-hospital resuscitation poor performance in ECC has been reported in recent years. Although several stand-alone devices have been developed none has been implemented as a standard in patient care. The aim of this study was to examine if the use of a mechanical device providing visual feedback and audible assistance during ECC improves performance of healthcare professionals following minimal and simplified instructions. Methods: In a prospective, randomized cross-over study 81 healthcare professionals performed ECC for 3 min (in the assumed setting of a secured airway) twice on a manikin (Skillreporter ResusciAnne®, with PC-Skillreporting System Version 1.3.0, Laerdal, Stavanger, Norway) in a mock cardiac arrest scenario. Group 1 (n=40) performed ECC with the device first followed by classic ECC and group 2 (n=41) in the opposite order. Minimal instructions were standardized and provided by video instruction (1 min 38 s). Endpoints were achievement of a mean compression rate between 90 and 110/min and a mean compression depth of 40-50 mm. In addition participants had to answer questionnaires about demographic data, professional experience and recent recommendations for ECC as well as their impression of the device concerning the ease of use and their personal level of confidence. Data were analyzed for group-related and inter-group differences using SAS (Version 9.1.3, SAS Institute, Cary, NC). Results: A total of 81 healthcare professionals regularly involved in resuscitation attempts in pre-hospital or in-hospital settings took part in the study with no differences between the groups: females 35.8% (n=52), emergency medical technicians 32.1% (n=26), anesthesia nurses 32.1% (n=26), physicians (anesthesiology) 45% (n=29). In group 1 33 out of 40 (82.5%; 99.7±4.82/min; 95% confidence interval 95% CI: 98.1-101.2/min) reached the correct range for compression rate and 29/40 (72.5%; 44.0±4.95 mm; 95% CI: 42.4-45.6 mm) the correct compression depth using the assisting device. Afterwards they conducted classic ECC without the device and deteriorated significantly: correct compression rate was achieved by 12/40 (30%, p≤0.0001; 110.6±11.0/min (95% CI: 107.1-114.1/min), while 25/40 (62.5%; 44.5±5.63 mm; 95% CI: 42.6-46.3 mm) met the correct compression depth. Group 2 performed poorer in ECC without assistance and 5/41 (12.2%; 104.5±21.35/min; 95% CI: 97.8-111.3/min) reached the correct rate whereas 21/41 (51.2%; 39.6±7.61 mm; 95% CI: 37.2-42.0 mm) compressed to the appropriate depth. Using the device there was a significant improvement in the second evaluation with 34/41 (82.9%, p≤0.0001; 101.7±4.68/min; 95% CI: 100.2-103.2/min) reaching the correct rate and 36/41 (87.8%, p≤0.0001; 43.9±4.16 mm; 95% CI: 42.6-45.2 mm) the correct depth. Conclusions: The tested device is easy to use after instruction of less than 3 min and improves ECC performance of healthcare professionals in simulated cardiac arrest with respect to compression depth as well as compression rate. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to evaluate the association of cardiopulmonary resuscitation (CPR) training with bystander resuscitation performance and patient outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This was a prospective, population-based cohort study of all persons aged 18years or older with OHCA of presumed intrinsic origin and their rescuers from January through December 2008 in Takatsuki, Osaka prefecture, Japan. Data on resuscitation of OHCA patients were obtained by emergency medical service (EMS) personnel in charge based on the Utstein style. Rescuers’ characteristics including experience of CPR training were obtained by EMS personnel interview on the scene. The primary outcome was the attempt of bystander CPR. Results: Data were collected for 120 cases out of 170 OHCAs of intrinsic origin. Among the available cases, 60 (50.0%) had previous CPR training (trained rescuer group). The proportion of bystander CPR was significantly higher in the trained rescuer group than in the untrained rescuer group (75.0% and 43.3%; p =0.001). Bystanders who had previous experience of CPR training were 3.40 times (95% confidence interval 1.31–8.85) more likely to perform CPR compared with those without previous CPR training. The number of patients with neurologically favorable one-month survival was too small to evaluate statistical difference between the groups (2 [3.3%] in the trained rescuer group versus 1 [1.7%] in the untrained rescuer group; p =0.500). Conclusions: People who had experienced CPR training had a greater tendency to perform bystander CPR than people without experience of CPR training. Further studies are needed to prove the effectiveness of CPR training on survival. [Copyright &y& Elsevier]

Abstract: Aim: Effective assessment of motor skills in large-size classes is a challenge in medical education. This case-study investigates whether a game can be considered a valid tool for the summative assessment of first aid and basic life support skills. Methods: Using a traditional exam as bench-mark, a board game format was experimentally trialed to assess students’ competency after taking a first aid course. Fifty-five students were randomly assigned to two groups. Two assessments, a game-based assessment and a traditional test, consisting of a paper-and-pencil test in combination with a skill assessment, were applied to both groups in opposite order. In both formats students acted as judges of other students’ efforts. In the game, the student''s outcome was equal to the number of cards collected by answering questions correctly as deemed by peers. Similarities between both assessment types included individual testing, type of assessor (peers), content, type of questions and demonstrations, and the use of checklists for skill assessment. The assessment methods differed in format (written or oral test, both in combination with skill assessment) and feedback availability. Results: Both groups performed equally in the game-based assessment as well as in the traditional test, in spite of the opposite order of the assessments. No significant difference was found between the mean scores on the game-based assessment and the traditional test. Conclusions: These data suggest that use of a game format for assessment purposes may provide an effective means of assessing students’ competence at the end of a practical course. [Copyright &y& Elsevier]

Abstract: Background: Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives: To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with rescue breathing for witnessed adult OHCA of cardiac origin. Methods: A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results: Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions: For prolonged OHCA of cardiac origin, conventional CPR with rescue breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR. [ABSTRACT FROM AUTHOR]

Abstract: Background: In cardiopulmonary resuscitation (CPR) of a patient with an unsecured airway performed by two health care professionals, two methods are possible: 1) Standard CPR according to the guidelines, with one rescuer performing chest compressions from the side and the other rescuer performing ventilations from over the head of the patient. Additional tasks (like attaching the electrocardiogram and defibrillator) must be performed by the second rescuer during the time between ventilations. 2) Over-the-head CPR, with one rescuer performing chest compressions and ventilations from over the head and the other rescuer performing additional tasks. Objectives: The aim of this study was to compare the quality of CPR achieved by the two methods. Methods: After a standardized theoretical introduction and practical training, 106 medical students with limited knowledge and training in CPR participated in this randomized crossover study. Students performed a 2-min CPR test of standard CPR in both positions and over-the-head CPR alone on a manikin. Results: Standard CPR led to a significantly shorter hands-off-time over a 2-min interval than over-the-head CPR (median 25 s [interquartile range (IQR) 22–26 s] vs. 38 s [IQR 36–43 s], respectively, p < 0.001), and significantly more chest compressions (167 [IQR 158–176] vs. 142 [IQR 132–150], respectively, p < 0.001), more correct chest compressions (72 [IQR 11–136] vs. 45 [IQR 13–88], respectively, p = 0.004), inflations (10 [IQR 10–10] vs. 8 [IQR 8–8], respectively, p < 0.001), and correct inflations (5 [IQR 2–7] vs. 3 [IQR 1–4], respectively, p < 0.001). Conclusions: In the case of a two-professional-rescuer CPR scenario, standard CPR enables a quantitatively better resuscitation than over-the-head CPR. [ABSTRACT FROM AUTHOR]

Abstract: Background: Video-based self-instruction (VSI) with a 24-min DVD and a personal resuscitation manikin solves some of the barriers associated with traditional basic life support (BLS) courses. No accurate assessment of the actual improvement in skills after attending a VSI course has been determined, and in this study we assess the skill improvement in laypersons undergoing VSI. Methods: The BLS skills of 68 untrained laypersons (high school students, their teachers and persons excluded from mainstream society) were assessed using the Laerdal ResusciAnne and PC Skill Reporting System 2.0 in a 3min test. A total score (12–48 points) was calculated and 12 different variables were recorded. The participants attended a 24-min VSI course (MiniAnne, Laerdal) and took home the DVD and manikin for optional subsequent self-training. We repeated the test 3½–4 months later. Results: There was a significant increase in the total score (p <0.0001) from 26.5 to 34 points. The participants performed significantly better in checking responsiveness, opening the airway, checking for respiration and using the correct compression/ventilation ratio (all p-values<0.001). The compression depth improved from 38mm to 49.5mm and the total number of compressions increased from 67 to 141. The ventilation volume and the total number of ventilations increased, and total “hands-off” time decreased from 120.5s to 85s. Conclusions: Untrained laypersons attending a 24min DVD-based BLS course have a significantly improved BLS performance after 3½–4 months compared to pre-test skill performance. Especially the total number of compressions improved and the hands-off time decreased. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR. Methods: This study involved 106 and 107 participants randomly assigned to chest compression-only CPR training and conventional CPR training, respectively. Immediately after training, participants were asked to perform CPR for 2min and the quality of their CPR skills were evaluated. The number of chest compressions in total and those with appropriate depth were counted every 20-s CPR period from the start of CPR. The primary outcome was the CPR quality index calculated as the proportion of chest compressions with appropriate depth among total chest compressions. Results: The total number of chest compressions remained stable over time both in the chest compression-only and the conventional CPR groups. The CPR quality index, however, decreased from 86.6±25.0 to 58.2±36.9 in the chest compression-only CPR group from 0–20s through 61–80s. The reduction was greater than in the conventional CPR group (85.9±25.5 to 74.3±34.0). The difference in the CPR quality index reached statistical significance (p =0.003) at 61–80s period. Conclusions: Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321) [ABSTRACT FROM AUTHOR]

Abstract: Background: Self-directed BLS-training, using a personal training manikin with video has been shown to be as effective as instructor-led training. This has not previously been investigated for AED-training. Materials and methods: This prospective, randomized study with a non-inferiority design compared traditional instructor-led training with three DVD-based AED-training methods (2.5min DVD without practice; 4.5min DVD with manikin practice; 9min DVD with manikin practice and scenario training). After DVD BLS-training, 396 participants were assigned to one of the four AED-training methods by randomization stratified for age. Participants were tested immediately after the training (post-test) and 2 months later (retention-test) using modified Cardiff criteria. The primary endpoint was the percentage of providers scoring 70% or higher on testing. The secondary endpoints were the mean scores and differences per item per age group. Results: Comparison non-inferiority could not be accepted for the post-test or retention-test. Relative risk (RR) and 95% confidence interval (CI) of passing for DVD without practice, with manikin practice and with manikin practice and scenario training compared to instructor-led training were 0.36 (0.25–0.53), 0.35 (0.24–0.51), 0.55 (0.38–0.79), respectively for the post-test, and 0.82 (0.68–0.97), 0.82 (0.68–0.97), and 0.84 (0.70–1.00), respectively for the retention-test. The performance of participants in all DVD-based training groups was significantly higher on the retention-test than on the post-test. Those receiving scenario training scored higher on the post-test compared to the other DVD-training groups (p <0.001). Conclusions: DVD-based AED-training without scenario is not recommended. Scenario training is a useful addition, but instructor-facilitated training remains the best method. [ABSTRACT FROM AUTHOR]

Abstract: Background: The increasing survival rates after out-of-hospital cardiac arrests (OHCA) are due mainly to improvements in the first 3 steps of the chain of survival. The aim of this study was to describe the temporal trends of OHCA incidence and outcomes with shock-resistant ventricular fibrillation (VF) requiring advanced life support procedures. Methods: All our subjects were persons aged 18 years or more who had suffered OHCA of presumed cardiac etiology, were witnessed by bystanders, treated by emergency medical service (EMS), and had VF as initial rhythm. Our study was conducted in Osaka Prefecture, Japan from May 1, 1998 through December 31, 2006. Data were collected by EMS personnel using an Utstein-style database. We evaluated the temporal trends of incidence and outcomes of shock-resistant VF. Results: During the study period, there were 8782 witnessed OHCA cases of presumed cardiac etiology. Among them, 1733 had VF as an initial rhythm, 392 of whom were shock-resistant. While the age-adjusted annual incidence of witnessed VF increased from 2.0 to 3.3 per 100,000 inhabitants, that of shock-resistant VF underwent little change during the study period. The proportion of shock-resistant VF among witnessed VF decreased from 37.0% to 19.0%. Neurologically intact 1-month survival rates after shock-resistant VF remained low at 5.6% even in 2006. Conclusion: The actual incidence of shock-resistant VF has remained unchanged, and their outcomes continue to be dismal. Further efforts are required to reduce the mortality rates of such shock-resistant VF to achieve improved survival after OHCA. [Copyright &y& Elsevier]

Abstract: Introduction: Quality of external chest compression (ECC) is a key component of Basic Life Support. Different approaches to improve rescuers’ performance have been evaluated, but few attempts have been made to invent simple devices to improve performance. This study evaluates a new visual feedback system for ECC for healthcare professionals. Methods: Ninety-three healthcare professionals volunteered (14 emergency medical technicians, 45 paramedics, 34 physicians; age 32±7.2 (range 21–61); 72% male) in this randomized cross-over study. All subjects were tested on a manikin (Skillreporter ResusciAnne®, Laerdal, Stavanger, Norway) in identical mock cardiac arrest scenario and asked to perform 2min of continuous ECC (secured airway): Group A (n =46): ECC with device first, followed by ECC without device a minimum of 45min later; group B (n =47): vice versa. Primary endpoints: mean compression rate 90–120min−1; mean compression depth 38–51mm. Data were analyzed using repeated measure logistic regression model for binary categorized endpoints and repeated measure ANOVA test for continuous endpoints. Results: Correct compression depth was achieved by 45.2% of subjects (95%-CI: 30.5–64.9mm) without vs. 73.1% (95%-CI: 40.3–57.4mm) with device (p <0.001); correct compression rate was achieved by 62.4% (95%-CI: 78–147.8min−1) without vs. 94.6% (95%-CI: 87.3–126.6min−1) with device (p <0.001). Overall, 85% of the subjects thought the feedback system was helpful and 80.6% would use it if available. Conclusions: The new visual feedback device significantly improved ECC performance (compression rate and depth) by healthcare professionals in simulated cardiac arrest. Most participants found the device easy to use. [Copyright &y& Elsevier]

Abstract: National resuscitation guidelines were published in Finland in 2002 and updated in 2006. The purpose of this study was to analyse the effect of cardiopulmonary resuscitation (CPR) education on attitudes towards defibrillation during arrests (CPR-D) and the guidelines. Methods: In 2003 (before CPR-D education) and in 2007 (after the education), 48-item questionnaires (using a 7-point Likert scale: 1=totally disagree, 7=totally agree) were sent to nurses in a secondary hospital. Factor loadings were applied using maximum likelihood factor analyses with a varimax rotation. Five scales were built from the items of the questionnaire: attitudes towards CPR-D, positive attitudes, negative attitudes towards guidelines, implementation and nurses’ role. Results: A total of 297 and 199 responded in 2003 and 2007, respectively. Education increased positive attitudes towards CPR-D (scale mean: 4.40 vs. 3.61, 95% confidence interval (CI): 3.9–4.2, P <0.001). Nevertheless, 27% of nurses hesitated to perform defibrillation because of fear of injuring patient and 64% because of anxiety. After education, negative attitudes towards guidelines increased (scale mean 2.94 vs. 3.92, 95% CI: 3.2–3.6, P <0.001) and nurses were more unsure about their role than before education (scale mean: 4.84 vs. 3.42, 95% CI: 4.1–4.4, P <0.001). Conclusions: Intensive education increased self-confidence regarding CPR-D skills but did not reduce anxiety. CPR-D education should include a focus on reducing anxiety, and negative attitudes within organisations need to be explored. [Copyright &y& Elsevier]

Abstract: Background: Research emphasises the need for instructional methods and tools which can improve Basic Life Support (BLS) performance or reduce instructional time. Aim: To investigate the effect of peer evaluation to improve reciprocal learning with task cards as instructional tools for acquiring BLS. Methods: A total of 78 kinesiology students from a Belgian university were paired and randomised across two groups to learn BLS in 20min with task cards. In the control group, students worked together in a defined doer–helper relationship and switched roles every 5min. In the peer evaluation group, students followed the same co-operation procedure as in the control group. In addition, 1min before every switching of roles, the helper evaluated the doer''s performance. All BLS skills were individually assessed on a Laerdal AED Resusci Anne mannequin (Laerdal Medical, Vilvoorde, Belgium) using the Laerdal PC-Skill reporting system. A total BLS score was calculated and performance was measured before training (baseline), immediately after training (intervention) and 2 weeks later (retention). Results: Significantly more students from the evaluation group remembered and consequently performed all BLS skills at intervention (P =0.03). No significant differences were found between groups for main cardiopulmonary resuscitation (CPR) variables and total BLS scores at baseline, intervention and retention. Both groups achieved more than 70% of the maximum BLS score at intervention and retention. Conclusions: This study demonstrated that 20min reciprocal-learning setting with task cards is an effective method to learn BLS. The implementation of peer evaluation in this setting has an immediate, however small, positive impact on BLS skill learning. [Copyright &y& Elsevier]

Abstract: Objective: To explore in detail the expected magnitude of systemic perfusion pressure during standard CPR as a function of compression frequency for different sized people from neonate to adult. Method: A 7-compartment mathematical model of the human cardiopulmonary system – upgraded to include inertance of blood columns in the aorta and vena cavae – was exercised with parameters scaled to reflect changes in body weight from 1 to 70kg. Results: Maximal systemic perfusion pressure occurs at chest compression rates near 60, 120, 180, and 250/min for subjects weighing 70, 10, 3, and 1kg, respectively. Such maxima are predicted by analytical models describing the dependence of stroke volume on pump-filling time in the presence of blood inertia. This mathematical analysis reproduces earlier experimental results of Fitzgerald et al. in 10kg dogs. Conclusions: Fundamental geometry and physics suggest that the most effective chest compression frequency in CPR depends upon body size and weight. In neonates there is room for improvement at the top of the compression frequency scale at rates >120/min. In adults there may be benefit from lower compression frequencies near 60/min. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the effectiveness of 1-h practical chest compression-only cardiopulmonary resuscitation (CPR) training with or without a preparatory self-learning video. Methods: Participants were randomly assigned to either a control group or a video group who received a self-learning video before attending the 1-h chest compression-only CPR training program. The primary outcome measure was the total number of chest compressions during a 2-min test period. Results: 214 participants were enrolled, 183 of whom completed this study. In a simulation test just before practical training began, 88 (92.6%) of the video group attempted chest compressions, while only 58 (64.4%) of the control group (p <0.001) did so. The total number of chest compressions was significantly greater in the video group than in the control group (100.5±61.5 versus 74.4±55.5, p =0.012). The proportion of those who attempted to use an automated external defibrillator (AED) was significantly greater in the video group (74.7% versus 28.7%, p <0.001). After the 1-h practical training, the number of total chest compressions markedly increased regardless of the type of CPR training program and inter-group differences had almost disappeared (161.0±31.8 in the video group and 159.0±35.7 in the control group, p =0.628). Conclusions: 1-h chest compression-only CPR training makes it possible for the general public to perform satisfactory chest compressions. Although a self-learning video encouraged people to perform CPR, their performance levels were not sufficient, confirming that practical training as well is essential. (UMIN000001046). [Copyright &y& Elsevier]

Abstract: Background: During cardiac arrest the paramount goal of basic life support (BLS) is the oxygenation of vital organs. Current recommendations are to combine chest compressions with ventilation in a fixed ratio of 30:2; however the optimum compression/ventilation ratio is still debatable. In our study we compared four different compression/ventilation ratios and documented their effects on the return of spontaneous circulation (ROSC), gas exchange, cerebral tissue oxygenation and haemodynamics in a pig model. Methods: Study was performed on 32 pigs under general anaesthesia with endotracheal intubation. Arterial and central venous lines were inserted. For continuous cerebral tissue oxygenation a Licox® PtiO2 probe was implanted. After 3min of cardiac arrest (ventricular fibrillation) animals were randomized to a compression/ventilation-ratio 30:2, 100:5, 100:2 or compressions-only. Subsequently 10min BLS, Advanced Life Support (ALS) was performed (100%O2, 3 defibrillations, 1mg adrenaline i.v.). Data were analyzed with 2-factorial ANOVA. Results: ROSC was achieved in 4/8 (30:2), 5/8 (100:5), 2/8 (100:2) and 0/8 (compr-only) pigs. During BLS, PaCO2 increased to 55mmHg (30:2), 68mmHg (100:5; p =0.0001), 66mmHg (100:2; p =0.002) and 72mmHg (compr-only; p <0.0001). PaO2 decreased to 58mmg (30:2), 40mmHg (100:5; p =0.15), 43mmHg (100:2; p =0.04) and 26mmHg (compr-only; p <0.0001). PtiO2 baseline values were 12.7, 12.0, 11.1 and 10.0mmHg and decreased to 8.1mmHg (30:2), 4.1mmHg (100:5; p =0.08), 4.3mmHg (100:2; p =0.04), and 4.5mmHg (compr-only; p =0.69). Conclusions: During BLS, a compression/ventilation-ratio of 100:5 seems to be equivalent to 30:2, while ratios of 100:2 or compressions-only detoriate peripheral arterial oxygenation and reduce the chance for ROSC. [Copyright &y& Elsevier]

Abstract: Studies have shown that the quality of chest compressions for cardiac arrest decreases markedly after only a brief time. This is thought to be an important contributor to an adverse outcome of resuscitation, which has led to recommendations to alternate chest compression providers. This study compared alternating rescuers every 1min versus every 2min in a manikin simulation. Forty pairs of rescuers were randomly assigned to either scenario. The main outcome measure was the number of effective compressions. The results were analysed using one-way analysis of variance. Over the full 8min, no significant difference was found in the number of effective chest compressions (p =0.707). Furthermore, no significant difference was found when comparing each 2min block. An explanation for this may be that the compressions lost due to fatigue in the 2min scenario are approximately offset by compressions lost due to the practicalities of changing over. Power calculations with these results show that an unfeasibly large number of scenarios would be needed to definitively demonstrate the superiority of one of the scenarios. It seems reasonable to alternate chest compression providers every 2min, to prevent the loss of effective compressions due to fatigue and to minimise interruptions of chest compressions. The ideal time to do this would be during the rhythm and pulse check as dictated by current guidelines. [Copyright &y& Elsevier]

Abstract: Aims: Basic Life Support Guidelines 2005 emphasise the importance of reducing interruptions in chest compressions (no-flow duration) yet at the same time stopped recommending Dual Operator CPR. Dual Operator CPR (where one rescuer does ventilations and one chest compressions) could potentially minimize no-flow duration compared to Single Operator CPR. This study aims to determine if Dual Operator CPR reduces no-flow duration compared to Single Operator CPR. Methodology: This was a prospective randomised controlled crossover trial. Medical students were randomised into ‘Dual Operator’ or ‘Single Operator’ CPR groups. Both groups performed 4min of CPR according to their group allocation on a resuscitation manikin before crossing over to perform the other technique one week later. Results: Fifty participants were recruited. Dual Operator CPR achieved slightly lower no-flow durations than the Single Operator CPR (28.5% (S.D.=3.7) versus 31.6% (S.D.=3.6), P ≤0.001). Dual Operator CPR was associated with slightly more rescue breaths per minute (4.9 (S.D.=0.5) versus 4.5 (S.D.=0.5), P =0.009. There was no difference in compression depth, compression rate, duty cycle, rescue breath flow rate or rescue breath volume. Conclusions: Dual Operator CPR with a compression to ventilation rate of 30:2 provides marginal improvement in no-flow duration but CPR quality is otherwise equivalent to Single Operator CPR. There seems little advantage to adding teaching on Dual Operator CPR to lay/trained first responder CPR programs. [Copyright &y& Elsevier]

Abstract: Introduction: The use of a personal resuscitation manikin with video instruction is reportedly as effective as traditional instructor-led courses in teaching lay people basic life support (BLS). We applied this method to an entire hospital staff to determine its effect on their practical and self-judged BLS skills. Methods: All 5382 employees at Stavanger University Hospital were asked to learn or refresh their BLS skills with the personal resuscitation manikin and video instruction. Prior to and nine months after training, all employees were asked to rate their BLS skills on a scale from one to five. Additionally, randomly chosen study subjects were tested for BLS skills pre-training and six months post-training during 2min of resuscitation on a manikin. Results: In total, 5118 employees took part in the BLS training program. The number of correct chest compressions increased significantly from 60 (5–102) to 119 (75–150) in the pre- vs. post-training periods, respectively, P <0.01, but the number of correct MTM ventilations did not change. Self-reported BLS skills increased from 3.1 (±1.0) pre-training to 3.8 (±0.8) post-training, P =0.031. Conclusion: After distributing a personal resuscitation manikin with video instruction to an entire hospital staff, the median number of correctly performed chest compressions doubled and self-confidence in BLS skills improved significantly. This is a simple and less time-consuming method than instructor-led courses in preparing hospital employees in the basic handling of cardiac arrest. [Copyright &y& Elsevier]

The article presents a study which aims to evaluate the retention of basic life support (BLS) knowledge of third year nursing and fourth year chiropractic students at Royal Melbourne Institute of Technology (RMIT) in Victoria. Study participants include 87 third year undergraduate nursing and 43 fourth year undergraduate chiropractic students. It revealed that chiropractic students have some difficulties in identifying correct compression rate compared to the nursing group.

Abstract: Purpose: To evaluate, in a hospital setting, the influence of different, common mattresses, with and without a backboard, on chest movement during CPR. Design and setting: Sixty CPR sessions (140s each, 30:2, C:R ratio 1:1) were performed using a manikin on standard hospital mattresses, with or without a backboard in combination with variable weights. Sternum-to-spine compression distance was controlled (range 30–60mm) allowing evaluation of the underlying compliant surface on total hand travel. Results: Movement of the caregiver''s hands was significantly larger (up to 111mm at 50mm compression depth, p <0.0001) when sternum-to-spine compressions were performed without a backboard than with one. The extent of this variable extra travel effect depended on the type of mattress as well as the force of compression. Foam mattresses and air chamber systems act as springs and follow hand movement, while ‘slow foam’ mattresses incorporate time delays, making depth and force sensing harder. A backboard decreases the extra hand movement due to mattress effects by more than 50%, strongly reducing caregiver work. Conclusions: Total vertical hand movement is significantly, and clinically relevantly much, larger than sternum-to-spine compression depth when CPR is performed on a mattress. Additional movement depends on the type of mattress and can be strongly reduced, but not eliminated, when a backboard is applied. The additional motion and increased work load adds extra complexity to in-hospital CPR. We propose that this should be taken into account during training by in-hospital caregivers. [Copyright &y& Elsevier]

Abstract: Aim: Stomach inflation during cardiopulmonary resuscitation (CPR) is frequent, but the effect on haemodynamic and pulmonary function is unclear. The purpose of this study was to evaluate the effect of clinically realistic stomach inflation on haemodynamic and pulmonary function during CPR in a porcine model. Methods: After baseline measurements ventricular fibrillation was induced in 21 pigs, and the stomach was inflated with 0L (n =7), 5L (n =7) or 10L air (n =7) before initiating CPR. Results: During CPR, 0, 5, and 10L stomach inflation resulted in higher mean pulmonary artery pressure [median (min–max)] [35 (28–40), 47 (25–50), and 51 (49–75) mmHg; P <0.05], but comparable coronary perfusion pressure [10 (2–20), 8 (4–35) and 5 (2–13) mmHg; P =0.54]. Increasing (0, 5, and 10L) stomach inflation decreased static pulmonary compliance [52 (38–98), 19 (8–32), and 12 (7–15) mL/cmH2O; P <0.05], and increased peak airway pressure [33 (27–36), 53 (45–104), and 103 (96–110) cmH2O; P <0.05). Arterial oxygen partial pressure was higher with 0L when compared with 5 and 10L stomach inflation [378 (88–440), 58 (47–113), and 54 (43–126) mmHg; P <0.05). Arterial carbon dioxide partial pressure was lower with 0L when compared with 5 and 10L stomach inflation [30 (24–36), 41(34–51), and 56 (45–68) mmHg; P <0.05]. Return of spontaneous circulation was comparable between groups (5/7 in 0L, 4/7 in 5L, and 3/7 in 10L stomach inflation; P =0.56). Conclusions: Increasing levels of stomach inflation had adverse effects on haemodynamic and pulmonary function, indicating an acute abdominal compartment syndrome in this CPR model. [Copyright &y& Elsevier]

Abstract: Aim: In order to elucidate the factors for willingness to perform CPR, we evaluated the responses of college students to questionnaires before and after basic life support (BLS) training. Methods: Before and after participating in a small group BLS course, 259 students completed questionnaires. A logistic regression model was used to elucidate independent factors for their willingness to attempt resuscitation. Results: Factors associated with willingness to perform BLS for strangers were “anxiety for a bad outcome” (odds ratio (OR) 0.08) and “having knowledge of automated external defibrillator (AED)” (OR 4.5) before training. The proportion of students showing willingness to perform BLS increased from 13% to 77% after the training even when the collapsed person is a stranger. After training, “anxiety for being sued because of a bad outcome” (OR 0.3), and “anxiety for infection” (OR 3.8) were significant factors. Those who preferred to perform BLS without ventilation increased from 40% to 79% (p <0.0001). Conclusion: The proportion of students showing willingness to perform BLS increased after the training. Significant association between “anxiety for infection” and willingness to perform BLS might indicate that those who wish to perform BLS developed their awareness of risk of infection more than the counterparts. For future guidelines for resuscitation and the instruction consensus, the reluctance of bystanders to perform CPR due to the hesitation about mouth-to-mouth ventilation should be reconsidered with other recent reports indicating the advantage of compression-only CPR. [Copyright &y& Elsevier]

Summary: Background: The ECG analysis algorithm of automated external defibrillators (AEDs) shows reduced sensitivity and specificity in the presence of external artifacts. Therefore, ECG analyses are preceded by voice prompts. We investigated if advanced life support (ALS) providers follow these prompts, and the consequences if they do not. Methods: In a two-tiered EMS system all 510 ECG analyses from 135 resuscitation attempts with a Laerdal® FR2 AED (applied by emergency medical technicians [EMTs] and subsequently used by ALS providers) were prospectively evaluated. The ALS data were compared with data before arrival of ALS providers (EMT data) using Mc Nemar test. Results: In the presence of ALS providers, 286 ECG rhythm analyses were performed. In the 96 analyses with shockable rhythms, artifacts were detected in 35 (36%), leading to a wrongful no shock decision in 19 (20%). Corresponding EMT data were 67 analyses with shockable rhythms, with artifacts in 18 (27%; p <0.001) but a wrongful no shock decision in only 3 (4%; p <0.001). ALS providers also failed to deliver the AED shock in 7 of the 77 analyses with an appropriate shock decision (9%). This was never found in the EMT data. In the 190 analyses of a non-shockable rhythm in the presence of ALS providers, artifacts were detected in 120 (63%) leading to one spurious shock (0.5%). Corresponding EMT data were 157 analyses, with artifacts in 87 (55%; p =0.20) but no spurious shocks. Conclusions: External artifacts were frequently found, sometimes leading to important errors. Consequently, more training is needed, especially for ALS providers. [Copyright &y& Elsevier]

Summary: Aim: To determine whether in patients with an ambulance response time of >5min who were in VF cardiac arrest, 3min of CPR before the first defibrillation was more effective than immediate defibrillation in improving survival to hospital discharge. Methods: This randomised control trial was run by the South Australian Ambulance Service between 1 July, 2005, and 31 July, 2007. Patients in VF arrest were eligible for randomisation. Exclusion criteria were: (i) <18 years of age, (ii) traumatic arrest, (iii) paramedic witnessed arrest, (iv) advanced life support performed before arrival of paramedics and (v) not for resuscitation order or similar directive. The primary outcome was survival to hospital discharge with secondary outcomes being neurological status at discharge, the rate of return of spontaneous circulation (ROSC) and the time from first defibrillation to ROSC. Results: For all response times, no differences were observed between the immediate defibrillation group and the CPR first group in survival to hospital discharge (17.1% [18/105] vs. 10.3% [10/97]; P =0.16), the rate of ROSC (53.3% [56/105] vs. 50.5% [49/97]; P =0.69) or the time from the first defibrillation to ROSC (12:37 vs. 11:19; P =0.49). There were also no differences between the immediate defibrillation group and the CPR first group, for response times of ≤ or > 5min: survival to hospital discharge (50.0% [7/14] vs. 25.0% [4/16]; P =0.16 or 12.1% [11/91] vs.7.4% [6/81]; P =0.31, respectively) and the rate of ROSC (71.4% [10/14] vs. 75.0% [12/16]; P =0.83 or 50.5% [46/91] vs. 45.7% [37/81]; P =0.54, respectively). No differences were observed in the neurological status of those surviving to hospital discharge. Conclusion: For patient in out-of-hospital VF cardiac arrest we found no evidence to support the use of 3min of CPR before the first defibrillation over the accepted practice of immediate defibrillation. [Copyright &y& Elsevier]

Summary: Objectives: To compare the quality of resuscitation between those with a simplified chest compression-only cardiopulmonary resuscitation (CPR) program and those with a conventional CPR program. Methods: The participants were randomly assigned to either the 120-min training program of chest compressions (chest compression-only CPR) or the 180-min training program of chest compressions and ventilations (conventional CPR). Main outcome measures were the net number of appropriate chest compressions during the 2-min test period and the proportion of appropriate chest compressions over the theoretically attainable number one month after the training. Results: 223 participants were enrolled and 104 in each group completed this study. The 2-min number of appropriate chest compressions was 86.1±57.2 in the chest compression-only CPR group, which was significantly greater than 57.1±30.2 in the conventional CPR group (p <0.001). The proportion of appropriate chest compressions was higher in the chest compression-only CPR group than in the conventional CPR group (47.1±31.1% versus 38.1±20.1%, p =0.022). Time without chest compressions during conventional CPR reached 85.5±17.0s out of 120s, which was significantly longer than that during chest compression-only CPR (33.9±10.0s, p <0.001). The total number of ventilations and the number of appropriate ventilations during 2min was 2.5±3.0 and 0.9±1.6, respectively. Conclusions: A simplified chest compression-only CPR program makes it possible for the general public to perform a greater number of appropriate chest compressions than the conventional CPR program (UMIN-CTR C0000000321). [Copyright &y& Elsevier]

Summary: Aim: The importance of ventilatory support during cardiac arrest and basic life support is controversial. This experimental study used dynamic computed tomography (CT) to assess the effects of chest compressions only during cardiopulmonary resuscitation (CCO-CPR) on alveolar recruitment and haemodynamic parameters in porcine model of ventricular fibrillation. Materials and methods: Twelve anaesthetized pigs (26±1kg) were randomly assigned to one of the following groups: (1) intermittent positive pressure ventilation (IPPV) both during basic life support and advanced cardiac life support, or (2) CCO during basic life support and IPPV during advanced cardiac life support. Measurements were acquired at baseline prior to cardiac arrest, during basic life support, during advanced life support, and after return of spontaneous circulation (ROSC), as follows: dynamic CT series, arterial and central venous pressures, blood gases, and regional organ blood flow. The ventilated and atelectatic lung area was quantified from dynamic CT images. Differences between groups were analyzed using the Kruskal–Wallis test, and a p <0.05 was considered statistically significant. Results: IPPV was associated with cyclic alveolar recruitment and de-recruitment. Compared with controls, the CCO-CPR group had a significantly larger mean fractional area of atelectasis (p =0.009), and significantly lower PaO2 (p =0.002) and mean arterial pressure (p =0.023). The increase in mean atelectatic lung area observed during basic life support in the CCO-CPR group remained clinically relevant throughout the subsequent advanced cardiac life support period and following ROSC, and was associated with prolonged impaired haemodynamics. No inter-group differences in myocardial and cerebral blood flow were observed. Conclusion: A lack of ventilation during basic life support is associated with excessive atelectasis, arterial hypoxaemia and compromised CPR haemodynamics. Moreover, these detrimental effects remain evident even after restoration of IPPV. [Copyright &y& Elsevier]

Summary: Aim: To examine the current status and problems of resuscitation management in Japan as demonstrated at the 2006 and 2007 Osaka Senri medical rallies. Methods: Using manikins, the quality of resuscitation was evaluated in 33 teams that participated in the medical rallies. The challenge was to deliver defibrillation shocks for ventricular fibrillation; data were recorded using the Laerdal PC Skill Reporting System (Norway). The teams were first subjectively (visually) evaluated by a panel of judges and these evaluations were later reaffirmed using video records. Results: A ∼30s delay was observed between the time of contact and initiation of chest compression in the teams that adopted the American Heart Association (AHA) method compared with those that adopted the European Resuscitation Council (ERC) method. Although the overall quality of chest compressions was very good, in several instances, the hand positions were inappropriate and complete chest recoil was not achieved. The left paddle was incorrectly positioned by all teams. Only 15.8% of the teams were able to deliver shocks with less than 10s of interruption between the chest compressions. Regarding interruption of chest compressions at confirmation of correct tracheal tube placement, among the eight teams that adopted the AHA method, pauses of more than 10s were confirmed in five (62.5%). Conclusions: Significant differences in performance between the AHA and ERC methods were observed. The ERC guidelines were more rational and suitable in terms of actual application than the AHA guidelines. [Copyright &y& Elsevier]

Summary: Aim: Feedback during CPR may facilitate quality in chest compressions, but has also been associated with caregiver complaints such as stiff wrists, the need for more force and increased fatigue. This concern about extra work is, when using the CPREzy™ with its own spring-loaded surface, particularly relevant in the face of an increased number of successive compressions. This manuscript evaluates the objective workloads for caregivers with and without the CPREzy™. Materials and methods: An air pressure driven, piston device was used to generate controlled compressions in a manikin model. The pressure was applied for chest compressions with each of the following: the cylindrical end of the piston, a wooden block as dummy for the CPREzy™, and the CPREzy™ itself. Three manikins with subjectively different spring compliances were selected for the tests. Series of 20 compressions were performed over a wide range of pressures. Results: No additional force is required to achieve a given depth of compression with or without the CPREzy™. However, some additional work is required, ranging from 21 to 26.5%. This work is caused by the longer compression distance associated with the need to compress two springs (e.g. the CPREzy™ and the chest wall) instead of one (e.g. the chest wall). Conclusion: The subjective feeling of increased rescuer fatigue with the CPREzy™ can, at least in part, be attributed to the extra work required for compressing the spring of the CPREzy™. Improved accuracy in chest compression depth is likely to be another, more significant, factor in rescuer fatigue. [Copyright &y& Elsevier]

Summary: Objectives: To develop new methods for studying correlations between the performance and outcome of resuscitation efforts in real-world clinical settings using data recorded by automatic devices, such as automatic external defibrillators (AEDs), and to explore effects of shock timing and chest compression depth in the field. Methods: In 695 records of AED use in the pre-hospital setting, continuous compression data were recorded using AEDs capable of measuring sternal motion during compressions, together with timing of delivered shocks and the electrocardiogram. In patients who received at least one shock, putative return of spontaneous circulation (P-ROSC) was defined as a regular, narrow complex electrical rhythm >40beats/min with no evidence of chest compressions at the end of the recorded data stream. Transient return of spontaneous circulation (t-ROSC) was defined as the presence of a post-shock organized rhythm >40beats/min within 60s, and sustained ≥30s. 2×2 contingency tables were constructed to examine the association between these outcomes and dichotomized time of shock delivery or chest compression depth, using the Mood median test for statistical significance. Results: The probability of P-ROSC for first shocks delivered <50s (the median time) after the start of resuscitation was 23%, versus 11% for first shocks >50s (p =0.028, one tailed). Similarly, the probability of t-ROSC for shorter times to shock was 29%, compared to the 15% for delayed first shocks (p =0.016). For shocks occurring >3min after initiation of rescue attempts, the probability of t-ROSC with pre-shock average compression depth >5cm was more than double that with compression depth <5cm (17.7% vs. 8.3%, p =0.028). For shocks >5min, the effect of deeper compressions increased (23.4% versus 8.2%, p =0.008). Conclusions: Much can be learned from analysis of performance data automatically recorded by modern resuscitation devices. Use of the Mood median test of association proved to be sensitive, valid, distribution independent, noise-resistant and also resistant to biases introduced by the inclusion of hopeless cases. Efforts to shorten the time to delivery of the first shock and to encourage deeper chest compressions after the first shock are likely to improve resuscitation success. Such refinements can be effective even after an unknown period of preceding downtime. [Copyright &y& Elsevier]