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Background: The multidisciplinary team caring for at-risk newborns should identify the risk factors for asphyxia early on. The team should be prepared for cardiopulmonary resuscitation and post-resuscitation care and have theoretical knowledge, practical skills, and ethical behaviors to minimize adverse events and provide safe care. Objective: To assess the knowledge of the multidisciplinary team about neonatal post-resuscitation care. Methodology: Cross-sectional study in a neonatal unit in Fortaleza-CE-Brazil. A questionnaire was administered to the multidisciplinary team, selected by convenience, and analyzed using the positivity index. Results: The team consisted mostly of women, aged 30 to 40 years, with a postgraduate degree, who had witnessed neonatal cardiorespiratory arrest and had attended a training course. They had an adequate knowledge positivity index (99.1%) regarding vital signs and oxygen saturation; borderline knowledge of blood gas dosage (71.8%), and poor knowledge (20.9% to 60.0%) about monitoring central venous pressure, urine output, blood glucose, and cardiac enzymes. Participants suggested using hard technologies, with only one professional recommending soft/relational technologies. Conclusion: There is a need for effective professional training, continuing education, and awareness-raising interventions to promote a holistic approach to newborn care. [ABSTRACT FROM AUTHOR]

Cardiorespiratory arrest (CPA) can be defined as the abrupt cessation of the heart's ventricular mechanical activity, along with breathing. Analyzing the knowledge of the nursing team of the municipal maternal and child hospital in Cacoal - RO on the performance of pediatric cardiopulmonary resuscitation (CPR); to evaluate the theoretical knowledge of the nursing team about the CPR 2020 protocol that work in pediatric patient care. Quali-quantitative study with a descriptive approach, with a transversal characteristic. The sample was obtained by convenience. Data were collected through a 14-question questionnaire, a questionnaire with multiple choice questions was applied to analyze the socio-demographic profile, and which evaluated theoretical-practical concepts of CPR care in pediatrics. The study is justified by the fact that the researchers have an understanding off the area of pediatrics, thus arising the interest in researching this topic and the degree of knowledge of professionals in the execution, and when observing the insecurity of nursing professionals facing a CRA, due to the lack of both theoretical and practical training. Thus, the opportunity emerged to analyze. [ABSTRACT FROM AUTHOR]

To outline the process of planning and developing a digital technology, serious game, aimed at assisting infant cardiopulmonary arrest by the nursing staff in an emergency care unit. Methodological study, developed according to Participatory Design in a Child Emergency Care unit. Participants corresponded to the nursing staff and expert judges. The construction of the game took place from the choice of the theme by the team, preparation of the script, referral to the computer team, making the game available to the subjects and subsequent evaluation. For that, the EGameFlow instrument was used. Expert judges evaluated the game as a technological innovation, attesting to its aptitude for application in the aforementioned population of interest. Given the potentially positive impact of using this type of tool in this complex care setting, the possibility of incorporating the use of the serious game into continuing health education strategies is envisaged, with a view to increasing the qualification of pediatric emergency care. [ABSTRACT FROM AUTHOR]

Cardiorespiratory Arrest (CRP) is the sudden interruption of heartbeat, breathing and immediate loss of consciousness. To identify the perception of the nursing team regarding the management of cardiorespiratory arrest in neonates in the NICU; To identify the factors in the work environment that interfere with the performance of the nursing team during the arrest and; Discuss the implications of this management for the clinical practice. This is a descriptive, qualitative study carried out in a NICU in Rio de Janeiro. Data were collected using a semi-structured questionnaire/interview instrument. Twenty-three nursing professionals participated and three categories were constructed: a) Perception of nursing professionals about performance and the management of neonatal CRP; b) Factors in the work environment that facilitate and hinder assistance; and c) Suggestions for improving service. The management of CRP is still a challenge for health professionals. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the simulation in cardiopulmonary arrest during the debriefing among nursing students in the COVID-19 pandemic. Method: a descriptive study with a qualitative approach carried out among 22 nursing students in two stages: clinical simulation in cardiopulmonary arrest and debriefing associated with the simulation. The textual corpus resulting from the dialogues was submitted to lexicographical analysis, with the aid of the "IRAMUTEQ" software. Results: most students had never participated in clinical simulation scenarios during graduation. Through the debriefing, facilitating aspects such as the manikin's voice and the realism of the simulation were identified. As difficulties, the students attributed nervousness and lack of knowledge in cardiopulmonary arrest care. Conclusion: in the evaluation of the simulation during the debriefing, the importance of this practical teaching strategy for academic training was verified, positively impacting the teaching-learning process of the nursing student, especially in the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest (CA) is a serious problem that requires the immediate intervention of third parties using basic life support (BLS). Objectives: To assess higher education health students' knowledge about BLS and analyze the associations between level of knowledge and sociodemographic, academic, and socio-educational variables. Methodology: Quantitative correlational cross-sectional study in a sample of higher education students. Results: The sample consisted of 683 students, with a mean age of 21 years, mostly women. The mean knowledge score was 11.79 points, on a scale of 0 to 20. There was a statistically significant association between the level of knowledge and the program, the year of study, having attended a BLS course/training, and having attended course units with BLS content. Conclusion: The mean scores reflect a sufficient level of knowledge, with the following groups obtaining higher scores: 4th-year students, nursing program, and previous BLS training. [ABSTRACT FROM AUTHOR]

Objective: To verify the knowledge of high school students about cardiopulmonary arrest and cardiopulmonary resuscitation and to evaluate learning immediately and late after theoretical and practical training. Methods: Longitudinal, prospective, quantitative experimental study, carried out in a public and a private institution, using a questionnaire on basic life support. The statistics were descriptive and inferential by the Friedman and Mann Whitney tests. Results: The students had insufficient knowledge, showing a significant improvement immediately and late. The two institutions had an equivalent performance in terms of correct answers in the immediate and late post-training periods. The stop signs, resuscitation maneuvers and steps to use the external defibrillator had lower success rates. Conclusion: After training, students demonstrated knowledge to act in the face of cardiac arrest and cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]

The quality of Cardiopulmonary resuscitation (CPR) depends on the systematization of actions, which are apply on cardiac arrest (PCR); such as the Basic Life Support (BLS). Therefore, the development of training in this field, aiming the spread of standardization of BLS, is especially important to achieve quality in CPR. This study aimed to describe the experience of Master's students of the Graduate Program in Nursing and Health of a Public University of the State of Bahia to develop a BLS workshop, which was administrated to health students. The workshop proposal on BLS was to promote a theoretical-practical approach based on reality. In this sense, a dialogued lecture was held, using audiovisual resources, containing the following theoretical contents: Epidemiology of diseases of the circulatory system; Symptomatology of an individual in PCR; Steps for recognizing a PCR situation; Evaluation sequence and conduct at each moment; Use of External Automated Defibrillator (AED) and Heimlich Maneuver in adults. It is of fundamental importance that the whole society has knowledge about the Basic Life Support protocols, since anyone can deal with an urgent or emergency situations, thus previous experience can be effective to help the victim. [ABSTRACT FROM AUTHOR]

Background: Knowledge about basic life support (BLS) in nursing students involves both technical skills (compressions and ventilations) and non-technical skills (clinical judgment and decision-making). Objectives: To assess nursing students' sociodemographic and academic characteristics; to assess nursing students' theoretical knowledge about BLS and analyze the association between nursing students' sociodemographic and academic characteristics and their theoretical knowledge about BLS. Methodology: Observational, descriptive, and correlational study with a sample of 496 nursing students selected using a nonprobability convenience sampling technique in two schools in the central region of Portugal. Results: Students demonstrated a good level of knowledge about BLS, with an average of 30.93 ± 2.29 on a scale from 0 to 37 points. They had a very good level of knowledge about safety conditions, the technical components of airway assessment, chest compressions, and ventilations. The level of knowledge is associated with age, year of undergraduate studies, and practical experience in BLS. Conclusion: Students have a good level of knowledge about BLS. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate the knowledge of nursing students in situations of cardiorespiratory arrest (CRA), according to the Brazilian literature. For this, an integrative descriptive and exploratory review was carried out at the Virtual Health Library. Articles in Portuguese, available in full, published between 2012 and 2017 were included in the research. In total, ten articles made up the sample. Thus, it was possible to identify nursing students who have heterogeneous levels of knowledge about CRA, since they present important changes in the percentage of correct and incorrect answers in the discussion points of the analyzed articles. In addition, feelings of inability to act appear as an aspect highlighted by some students in these studies. These reports may point to the need for more effective training for these professionals, in view of the importance of nursing performance in the face of patients in CRA. [ABSTRACT FROM AUTHOR]

Objective: to develop and validate a script to plan and execute the first stage of the clinical simulation of Basic Life Support in adults in cardiorespiratory arrest: the preparation and its pre-simulation and pre-briefing/ briefing phases. Method: methodological study performed through an integrative review with a sample of seven primary studies. Afterwards, content validation was carried out in June 2020 with 16 nurses. Results: the script consisted of pre-simulation and pre-briefing/briefing and achieved a total Content Validity Index of 0.90. Conclusion: a script was developed addressing the title, execution time, definition and objectives of the pre- simulation and pre-briefing/briefing, target audience, learning objectives, material resources, procedure and references, considered valid in its content to plan and execute the first stage of the clinical simulation of Basic Life Support in adults, that is, its preparation. [ABSTRACT FROM AUTHOR]

This study aims to report the experience and results of the "Mãos que Salvam" extension project conducted in Governador Valadares, Minas Gerais. The text explains the planning and development of the workshops, as well as the principal results of and difficulties observed during the project's implementation. Workshops covered the following topics: first aid, fainting, bleeding, burns, and airway clearance. Students were classified according to the percentage of correct answers (insufficient <60%, and satisfactory ≥60% correct answers). Researchers applied the Chi-Square test both before and after the workshops to compare students' questionnaire performance. Complementarily extension workers participated in two professional fairs, teaching life saving skills for use in instances of cardiorespiratory arrest and cardiopulmonary resuscitation. During the first semester of 2019, one school with nine (267 students) held the workshops. There was an improvement in the percentage of satisfactory performance in the questionnaires (53.18 vs. 95.07%, p <0.001) after the workshops. These results occurred in all elementary school classes, but not in high school classes. Nearly 300 students participated in the professional fairs. Observed data point out that the workshops developed skills and the ability to recognize emergencies, particularly in elementary school students. These results demonstrate that extension actions in schools may contribute to the dissemination of specific knowledge beyond the classroom. [ABSTRACT FROM AUTHOR]

Introduction: The use of realistic simulation methodology is used in several learning scenarios, allowing students to participate directly in the problematization of situations that require immediate professional action. Objective: To develop, validate and validate a low cost simulator for cardiopulmonary resuscitation and resuscitation procedures in infants. Methods: An experimental study carried out with undergraduate students of the 1st year of the Nursing course at a higher education institution in the State of Paraíba, developed a simulator model with dimensions similar to an infant with low cost materials and made possible the use as a prototype for Basic Life Support training. The prototype was developed with the accessories for disengagement and cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the American Hearth Association Basic Life Support guideline to enable and validate the Basic Life Support training instrument. Results: The low-cost prototype for Basic Life Support training was used as a learning object adequately and enabled the teaching-learning process as an accessible resource at low cost. Based on the questionnaire applied, we observed that there was an increase in the median number of correct answers and a reduction in the median of errors, which indicated an improvement in the acquisition of information and improvement in learning, observed through the test of Signal of Related Samples and the test of the Signs of Wilcoxon, (MA) and errors (ME), before and after training where it was found that there was an increase in MA and a reduction in ME with 5% significance (p <0.001). The frequencies of response modifications after training with the simulator were also studied by means of the two-tailed McNemar test where Q1, Q2, Q3, Q4, Q8, Q9, Q13 and Q15 questions showed significant changes (p <0, 05). Conclusion: A prototype was developed that simulated the training activity in Basic Life Support, which made it possible to carry out the procedures appropriately in positioning and simulation of cardiac resuscitation, mouth / nose ventilation, and tapping in the scapular region. Which allowed the validation of disengagement and resuscitation training as a low cost alternative for health education. [ABSTRACT FROM AUTHOR]

Trauma is still one of the main causes of morbidity and mortality worldwide. Traumatic cardiac arrest (TCA) stands out among the causes of death of these patients. Multiple authors claim that, despite medical advances, resuscitation efforts in these patients may lead to poor outcomes, since those suffering from TCA have high mortality rates and poor neurological prognosis. This article compiles the available evidence, which despite being limited, points to recent advances in the management and approach of these patients. The aim of this review is to reach a consensus on the approach to patients in cardiac arrest in the context of trauma, based on the most recent literature and evidence. [ABSTRACT FROM AUTHOR]

Objective: Teaching basic life support to schoolchildren is well established as one of the most effective strategies in increasing bystander CPR rates. However, there is a lack of scientific evidence concerning the Portuguese pediatric population. The present study aims to evaluate the outcome of a basic life support training session on theoretical knowledge and self-efficacy, immediately after the training and 6 months later, in a pediatric population. Methods: A total of 392 schoolchildren, aged seven to 12 years old, participated in this prospective longitudinal study, answering a questionnaire before, immediately after, and six months after receiving 120 minutes of resuscitation training from medical students. Results: There was a significant increase in the knowledge and self-efficacy after one single training session. Both decreased over a period of six months but remained significantly higher than the baseline. These results were homogeneous across classes. Conclusions: Medical students provided adequate basic life support training to a group of Portuguese schoolchildren, with effects in the knowledge and self-efficacy lasting for at least six months. [ABSTRACT FROM AUTHOR]

The study was developed with the purpose of investigating the difficulties faced by nursing professionals in the mobile pre-hospital care to the cardiorespiratory arrest. It is a narrative review study that was conducted after the publication of publications, restricted to the period from 2008 to 2018. The research was carried out using the platform provided by the Virtual Health Library (VHL) through the main descriptors: nursing, cardiorespiratory arrest and cardiopulmonary resuscitation. The participation of nursing professionals in the care of patients with CRA is important because they have a leadership and management role in relation to emergency care, but if the lack of knowledge and inexperience are present, it is problematic to offer a quality care. We emphasize the importance of being prepared to offer adequate care to patients in out-of-hospital settings, through the SAMU, leads to understanding that there is more development of health education, being promoted by nurses in their respective institutions, to reduce this lack of preparation of the team and improve the quality of care. [ABSTRACT FROM AUTHOR]

Objective: To report the experience of training caregivers of patients with chronic renal failure about basic life support based on the problematization methodology. Methods: It is an experience report of a training developed with 15 caregivers of patients with Chronic Renal Failure in June 2018. To meet the problematization method, we proposed to use the Arco de Manguerez through four stages: observation of reality, survey of key points, theorization and application to reality. Results: Strategies such as conversation wheel, semi-structured interview, training with practical simulation of cardiopulmonary arrest recognition and cardiopulmonary resuscitation maneuvers were used, with subsequent evaluation of the activity developed. The training provided the dissemination of essential knowledge for people who manage the care of patients with chronic diseases, such as Chronic Renal Failure, who can progress to cardiac arrest. Conclusion: The problematization made it possible for caregivers to participate in the educational process as active subjects, extrapolating the condition of spectators. [ABSTRACT FROM AUTHOR]

Introduction: Training nursing students in cardiopulmonary resuscitation (CPR) maneuvers is essential for safe and quality performance in different nursing performance scenarios. CPR integration into clinical practice settings, from the early years of the degree, provides greater confidence when performing it in emergency situations. The study aimed to evaluate the knowledge of newly graduated nursing students before and after receiving Basic Life Support (BLS) training through simulation. Materials and Methods: A quasi-experimental study was conducted at a public higher education institution in southeastern Brazil in 2015. The students answered a pre-test and, right after the intervention, answered a post-test. For the analysis, the McNemar and Wilcoxon paired tests were used. Results: Students were identified as having satisfactory knowledge (≥ 80%) on several subjects immediately after taking the course. However, the test questions related to the links in the chain of survival (-18.7%; p = 0.004) and to the steps of open airway maneuver (-16.0%; p = 0.091) indicated a reduction in the number of correct answers after the intervention. Discussion: The use of combined strategies, including the medium-fidelity simulation for teaching BLS, has facilitated the understanding of BLS content. Conclusions: The use of simulation showed a positive evolution of knowledge related to the depth of chest compression, the sequence of CPR steps and the compression-ventilation ratio for CPR per minute. [ABSTRACT FROM AUTHOR]

To evaluate the level of knowledge of the nursing team about the Basic Life Support in Cardiopulmonary Resuscitation and to identify difficulties faced by the nursing team in the care of patients with CRP. Descriptive type field research with a quantitative-qualitative approach, performed with nurses and nursing technicians of a public hospital in a city near the Federal District. Professionals showed significant deficits in the knowledge to the CRP care, because the percentage of correct answers was always below 50%. The nursing team studied showed deficits in the knowledge about the SBV in cardiorespiratory arrest. The low number of correct answers in the questions shows the need to update these professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of individual and team care for cardiac arrest in a pediatric hospital using clinical surprise simulation (in situ mock code). Methods: We conducted an observational study with a sample of the hospital staff. Clinical simulations of cardiorespiratory arrest were performed in several sectors and work shifts. The mock code occurred in vacant beds of the sector without previous notification to the teams on call. One researcher conducted all mock codes and another evaluated individual and team attendance through a questionnaire contemplating recommendation for adequate cardiopulmonary resuscitation, based on the Pediatric Advanced Life Support (PALS) guidelines. At the end of the simulations, the research team provided a debriefing to the team tested. Results: Fifteen in situ mock code were performed with 56 nursing professionals (including nurses, nursing residents and technicians) and 11 physicians (including two pediatric residents and four residents of pediatric subspecialties). The evaluation showed that 46.7% of the professionals identified cardiac arrest checking for responsiveness (26.7%) and pulse (46.7%); 91.6% requested cardiac monitoring and venous access. In one case (8.3%) the cardiac compression technique was correct in depth and frequency, while 50% performed cardiopulmonary resuscitation correctly regarding the proportion of compressions and ventilation. According to PALS guidelines, the teams had a good performance in the work dynamics. Conclusions: There was low adherence to the PALS guidelines during cardiac arrest simulations. The quality of cardiopulmonary resuscitation should be improved in many points. We suggest periodical clinical simulations in pediatric services to improve cardiopulmonary resuscitation performance. [ABSTRACT FROM AUTHOR]

Evaluate the level of knowledge of physical education students at a University Center in the Federal District regarding recognition, attitude and practice in the face of cardiorespiratory arrest. This is a descriptive and quantitative research, which was conducted in a University Center of the Federal District, through a questionnaire directed to physical education students who were in accordance with the selection criteria and wished Participate. All academics have demonstrated to have some kind of knowledge about CRP, but do not declare themselves able to perform some kind of intervention. It is possible to note that academics have a relative knowledge about CRP and the first care to be provided to the victim, but still show insecurity for performing CPR maneuvers efficiently, which suggests the application of course extensionists, updating and improving these undergraduates. [ABSTRACT FROM AUTHOR]

Assistance in emergency situations such as cardiorespiratory arrest, led to the appearance of several health services in the care of these victims. Effective care in CPR contributes to survival. About 54 to 74% of the CRP rhythms are ventricular atrial fibrillation, in which the treatment is defibrillation associated with cardiac compressions. The role of the nurse is related to the articulation, integration of the team in an interrelationship in the diverse situations in the RCP. The objective of this research was to identify the importance of the role of nurses in the implementation of adult resuscitation protocol changes. The methodology is based on the temporal analysis of the CPR protocols considering the first guideline. It was possible to affirm that the initial and critical elements of CPR are chest compressions and early defibrillation, in which we signal the importance of the role of the nurse in face of the modifications and implementation of these changes. [ABSTRACT FROM AUTHOR]

To describe the structure of Basic Health Units (UBS) in attending the Basic Support of Life (SBV). A transversal, descriptive, quantitative study developed in 13 UBSs of a municipality in the interior of the state of São Paulo, Brazil, between December 2013 and June 2014, through structured interviews with people in charge and through the observation of the structure. A specific script was prepared for the study. Not all units had all the materials, equipments and space required for SBV care. Only items such as adult bag-valve-mask and gloves were extant in all the units. Results show that most UBSs were minimally prepared for SBV attendance, with serious gaps in the organization and disposition of materials. [ABSTRACT FROM AUTHOR]

To describe the structure of Basic Health Units (UBS) in attending the Basic Support of Life (SBV). A transversal, descriptive, quantitative study developed in 13 UBSs of a municipality in the interior of the state of São Paulo, Brazil, between December 2013 and June 2014, through structured interviews with people in charge and through the observation of the structure. A specific script was prepared for the study. Not all units had all the materials, equipments and space required for SBV care. Only items such as adult bag-valve-mask and gloves were extant in all the units. Results show that most UBSs were minimally prepared for SBV attendance, with serious gaps in the organization and disposition of materials. [ABSTRACT FROM AUTHOR]

Mortality from external causes is considered a serious economic, social and public health problem. The main cause of death in the world is cardiorespiratory arrest, in Brazil this is mainly due to the lack of knowledge of basic life support. The victim's care and evaluation should be performed quickly and effectively, which will influence the survival and presence of sequelae. In this way, the importance of knowledge and practical implementation of basic life support in the evaluation of obtaining the license to drive vehicles, considering that these future drivers will be the potential audience that will witness these accidents and may start the aid more quickly, and with the appropriate knowledge, more effectively. Systematic review methodology. Empowering the population that is involved in the middle of traffic occupies a strategic position to promote victim assistance. It is undeniable that education and training in first aid can be useful to improve morbidity and mortality. [ABSTRACT FROM AUTHOR]

the main objective of this study was to relate the experience of the Heart Rescue Project, in the city of Salvador, Bahia state, in Brazil. Method: the report is about an experience with the Heart Rescue Project developed by SAMU 192, in which the population was trained in cardiopulmonary resuscitation. Also, through the project were distributed defibrillation equipments for health care spaces. Results: were trained 6,287 people linked to places like health services, public agencies, transfer stations and tourist sites. The addressed content, in the theoretical and practical activities, was based on the American Heart Association protocols for cardiopulmonary resuscitation. To the health units that participated in the training, 200 defibrillators were distributed. Conclusions: the population that received the training was stimulated to act in situations of cardiac arrest. The knowledge imparted increases the probability of obtaining a survival without sequelae, therefore it is believed that this would help new courses of training. [ABSTRACT FROM AUTHOR]

This article reports on the experience of academic monitoring in the application of Cardiopulmonary Resuscitation (CPR) during practical classes in the Medical Emergencies module in Dentistry. A demonstration of CPR was performed using an adult mannequin and appropriate accessories. CPR consists of chest compressions and mechanical ventilation to maintain blood circulation in cases of medical emergencies. It is concluded that CPR is essential for emergency care and it is important to be taught during undergraduate studies. [Extracted from the article]

Background: Measuring survival from sudden out-of-hospital cardiac arrest (OOH-CA) is often used as a benchmark of the quality of a community’s emergency medical service (EMS) system. The definition of OOH-CA survival rates depends both upon the numerator (surviving cases) and the denominator (all cases). Purpose: The purpose of the public access defibrillation (PAD) trial was to measure the impact on survival of adding an automated external defibrillator (AED) to a volunteer response system trained in CPR. This paper reports the definition of OOH-CA developed by the PAD trial investigators, and it evaluates alternative statistical methods used to assess differences in reported “survival.” Methods: Case surveillance was limited to the prospectively determined geographic boundaries of the participating trial units. The numerator in calculating a survival rate should include only those patients who survived an event but who otherwise would have died except for the application of some facet of emergency medical care—in this trial a defibrillatory shock. Among denominators considered were: total population of the study unit, all deaths within the study unit, and documented ventricular fibrillation cardiac arrests. The PAD classification focused upon cases that might have benefited from the early use of an AED, in addition to the likely benefit from early recognition of OOH-CA, early access of EMS, and early cardiopulmonary resuscitation (CPR). Results of this classification system were used to evaluate the impact of the PAD definition on the distribution of cardiac arrest case types between CPR only and CPR + AED units. Results: Potential OOH-CA episodes were classified into one of four groups: definite, probable, uncertain, or not an OOH-CA. About half of cardiac arrests in the PAD units were judged to be definite OOH-CA events and therefore potentially treatable with an AED. However, events that occurred in CPR-only units were less likely to be classified as definite or probable OOH-CA events than those in CPR + AED units (43% versus 55%, odds ratio 0.78, 95% confidence interval 0.57–1.07). The study retained sufficient power to permit a statistical analysis of the alternative hypothesis that the CPR + AED method results in twice as many survivors as a CPR-only approach. The result is critically dependent on the denominator used for calculating survival rates; but the analysis does not require a denominator as the numerators will have identical Poisson distributions (counts for rare events) under the null hypothesis since randomization distributes the risk of cardiac arrest evenly between the two arms. Conclusion: Reported OOH-CA rates and survival rates vary widely, depending upon the definitions applied to events. Rigorous assessment of treatments applied to improve survival can be obscured by inappropriate definitions. Large-scale randomized interventions designed to improve survival from OOH-CA can be evaluated based upon the absolute numbers of patients surviving, rather than a change in the proportion surviving. [Copyright &y& Elsevier]

Background: Standard cardiopulmonary resuscitation (CPR) is performed by kneeling adjacent to the side of the casualty. In certain circumstances it may be difficult or impossible to perform CPR in this position, for example in confined spaces such as a narrow corridor, aircraft or train gangway. The aim of this study was to investigate the technique of over-the-head CPR (OTH CPR), where the CPR provider kneels above the casualty and performs chest compressions OTH of the casualty. Methods: Twenty volunteers were randomised to a cross over trial where they performed standard and OTH CPR at a 7-day interval. Compression and ventilation variables were recorded on the Laerdal Resusci Annie VAM system. Results: Chest compression depth and ventilation volume declined over time (0-3 min P < 0.001). There was no difference in compression rate, depth, duty cycle or ventilation rate, inflation rate and ventilation volume between techniques. Hand position was incorrect more frequently in the standard compared to the OTH group (incorrect compressions 300 versus 76, respectively, P < 0.001) due principally to a greater proportion of low positioned compressions in the standard CPR group. Conclusion: OTH CPR appears equally effective as standard CPR with some marginal advantages in correct hand placement. We suggest that in situations where it is not possible to perform standard CPR, OTH CPR may be considered as a suitable alternative. [ABSTRACT FROM AUTHOR]

Background: Although resuscitation from cardiac arrest prevents more deaths from acute myocardial infarction (MI) than any other treatment, results have not been audited widely nor performance standards proposed. Methods: The Myocardial Infarction National Audit Project (MINAP) uses electronic transmission of a 53-item dataset to a central cardiac audit database (CCAD). From October 2000 to August 2002, transmission by 218 hospitals of data from 55,906 cases of MI with 4934 attempted resuscitations from a first arrest, allowed for examination of factors determining survival, and for possible future measurement of success in resuscitation as a performance indicator. We investigated two possible indicators: (i) numbers of survivors from arrest in ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) per 1000 cases of MI; and (ii) observed/expected (O/E) ratios for survival taking all VF/VT arrests rather than MI as the denominator, and adjusting for differing age structures and admission delays among individual hospitals. Findings: Of the 4934 reported patients suffering a first arrest, 1778 (36%) survived to be discharged from hospital. The presenting rhythm was VF/VT in 2321 (47%) patients of whom 1461 (63%) survived. Survival for all 218 hospitals together had the relatively small 95% confidence limits of 26 (25–27) survivors from VF/VT per 1000 MI. However, the small numbers from individual hospitals made it impossible in most cases, whichever of the two indicators was used, to separate quality of performance and completeness of reporting from the factor of chance. Interpretation: Audit of success in resuscitation is essential if performance in the treatment of MI is to be assessed. However, the relatively small numbers of arrests occurring in individual hospitals means that if year on year improvements are to be documented, audit must be carried out among groups of hospitals or on a national scale. [Copyright &y& Elsevier]

Very little evidence is available that supports or disproves the use of medications in neonatal resuscitation. In this randomized controlled trial, we evaluated the effect of sodium bicarbonate given during neonatal resuscitation, on survival and neurological outcome at discharge. Subjects and methods: Consecutively born asphyxiated neonates continuing to need positive pressure ventilation at 5 min of life received either sodium bicarbonate or 5% dextrose. The study group was given intravenous sodium bicarbonate solution 4 ml/kg (1.8 meq./kg) over 3–5 min. This solution was prepared by diluting 7.5% sodium bicarbonate (0.9 meq./ml) with distilled water in a 1:1 ratio. The placebo group received 4 ml/kg of undiluted 5% dextrose at a similar rate. The surviving neonates were evaluated for their neurological status at discharge. Primary outcome variable: Death or abnormal neurological examination at discharge. Secondary outcome variables: Encephalopathy, multi-organ dysfunction, intraventricular haemorrhage (IVH) and arterial pH at 6 h. Results: Twenty-seven babies were randomized to receive sodium bicarbonate (bicarb group) and 28 to receive 5% dextrose. Eighteen of the 27 (66.7%) babies in the bicarb group and 19 of the 28 babies (68%) in the dextrose group survived to discharge (P=0.84). Twenty-eight percent of the survivors in the bicarb group and 32% of the survivors in the dextrose group were neurologically abnormal at discharge (P=0.10). The composite primary outcome of death or abnormal neurological examination at discharge was similar in both groups (52% versus 54%, P=0.88). The incidence of encephalopathy (74% versus 63%), cerebral oedema (52% versus 30%), need for inotropic support (44% versus 29%), intraventricular haemorrhage (IVH) and the mean arterial pH at 6hrs were similar between the two groups. Conclusion: Administration of sodium bicarbonate during neonatal resuscitation did not help to improve survival or immediate neurological outcome. [Copyright &y& Elsevier]

Background: Lack of skills on how to diagnose and manage obstetric emergencies contribute to substandard institutional care and preventable maternal deaths in Brazil. Simulation-based obstetric emergency team training can reduce adverse maternal outcomes. However, this type of training is expensive and not widely available, especially in low resource settings. We present the experience of a private-public partnership that offered a two-day obstetric emergency simulation-training course to hundreds of Brazilian professionals working in the public sector. We also present participants´ short-term learning outcomes (Kirkpatrick's level 2) and satisfaction (Kirkpatrick's level 1). Methods: This was a non-experimental before-and-after study. The free 16-h course was held over a 14 months period in a large private hospital's simulation center using multidisciplinary scenario and model-based training. The training sessions consisted of four (4-h) modules on pre-eclampsia/eclampsia, hemorrhage, sepsis and resuscitation. An anonymous questionnaire collected participants´ satisfaction at the end of each module. Learning outcomes were assessed by comparing differences in participants´ pre- versus immediate post-course test scores. Wilcoxon, Kruskal-Wallis and Friedman tests were used for statistical analyses. P < 0.05 was considered significant. Results: 340 professionals (117 doctors, 179 registered nurses-RN and 44 licensed practical nurses-LPN) working in 33 public Brazilian hospitals were trained. There was a significant increase in post-course test scores in all four modules. On average, scores increased 55% in the hypertension and 65–69% in the hemorrhage, sepsis and resuscitation modules (p = 0.019). Knowledge acquisition of RN and LPN was similar in the hypertension, hemorrhage and sepsis modules and significantly higher than doctors´ (p < 0.05). On a 0 to 10 scale, mean overall satisfaction ranged from 9.6 (for the hypertension module) to 9.8 (for the resuscitation module). Conclusions: This successful experience of a private-public partnership to offer obstetric emergency simulation training required strategic organization and a strong commitment from both sides. This promising private-public partnership model could be replicated in similar settings. The training course obtained high satisfaction scores and significantly improved the knowledge of public-sector health professionals on how to manage the main causes of maternal mortality. [ABSTRACT FROM AUTHOR]