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A code blue event is an emergency code to indicate when a patient goes into cardiac arrest and needs resuscitation. In this paper, we model the binary response of a intensive care unit (ICU) patients experiencing a code-blue event, starting with vital time-series data of patients in 12 ICU beds. Our study introduces day-of and day-ahead risk scoring models trained against ground truth information on per-patient-per-day code-blue events, starting with multi-variate vital-time-series-sequences of varying durations with a plurality of engineered features capturing temporal variations of these signals. Actionable events, including code-blue events, aggregated by patient by day were predicted on the day-of or day-ahead with an overall accuracy of over 80% in our best models. Such models have potential to improve healthcare delivery by providing just-in-time alerting, enabling proactive and preventative clinical interventions, through continuous patient monitoring.

Extended Reality (XR) is a simultaneous combination of the virtual and real world. This paper presents the details of the framework and development methods for an XR basic life support (XR-BLS) simulator, as well as the results of an expert usability survey.The XR-BLS simulator was created by employing a half-torso manikin in a virtual reality environment and using BLS education data that is in line with the 2020 American Heart Association guidelines. A head-mounted display (HMD) and hand-tracking device were used to perform chest compressions and ventilation and to enable the use of an automated external defibrillator in a virtual environment. A usability study of the XR-BLS simulator through an expert survey was also conducted. The survey consisted of a total of 8 items: 3, 2, and 2 questions about the ease of use of XR-BLS, delivery of training, and artificial intelligence (AI) instructor in the simulator, respectively.The XR simulator was developed, and the expert survey showed that it was easy to use, the BLS training was well delivered, and the interaction with the AI instructor was clear and understandable.The XR-BLS simulator is useful as it can conduct BLS education without requiring instructors and trainees to gather.

Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I2 = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD − 0.78; 95% CI − 1.39; − 0.18; I2 = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.

Survival following cardiac arrest and subsequent cardiopulmonary resuscitation (CPR) is increasing worldwide, mainly due to greater awareness of the symptoms of cardiac events and an increased attention to CPR training. Although patient outcomes remain unpredictable and quantitative studies suggest that the overall quality of life (QOL) is acceptable, it is valuable to synthesise qualitative studies exploring these phenomena in depth, providing a deeper knowledge of survivors' experiences and QOL.To critically appraise and synthesise the qualitative literature on survivors' experiences of a cardiac arrest and CPR with the aim of identifying common themes that can inform clinical pathways and thereby improve survivor outcomes and QOL.A systematic review and meta-synthesis of the qualitative literature, using Thomas and Harden's framework, and confined to peer-reviewed papers published from 2000 to 2015, which were identified through database searches of EBSCO, OVID and ProQuest.The search produced 204 papers, and of these, seven relevant papers were identified for review. Data extraction included setting, participants, research design, data collection, analysis and themes. Five qualitative themes were identified and were the subject of this meta-synthesis: multitude of contrasting feelings; disruption in the continuum of time; new reality and psychological challenges; changed body with new limitations; and confrontation with death.This review provides insights into the experiences of survivors' QOL after CPR. Increased knowledge can improve person-centred care in the immediate and forthcoming care after the event, both in terms of planning for discharge and in the future care of people who survive a cardiac arrest.

Objective The aims of the present study were to establish rates of resuscitation order documentation of patients aged ≥65 years from both psychogeriatric and general medical units and to compare patients on predictors of resuscitation status, particularly examining the effect of depression. Methods A retrospective case note audit of psychogeriatric (n=162) and general medical (n=135) unit admissions within a tertiary teaching hospital was performed. Multivariate logistic regression was used to determine significant clinical and demographic predictors of resuscitation status. Results Resuscitation orders were documented in more psychogeriatric (94.4%) than general medical (48.1%) files. Depression did not significantly predict resuscitation status in either group. Having undergone competency assessment significantly predicted resuscitation status for the total sample and separately for psychogeriatric and medical patients. Older age (overall sample), poorer prognosis (overall sample), living in residential care (overall sample and medical group) and self-consenting to resuscitation status (overall sample and medical group) significantly predicted resuscitation status. Conclusions Resuscitation orders were more frequently documented on the psychogeriatric unit. Further prospective analysis is needed of how resuscitation orders are made before depression is discounted as a predictor of end-of-life decision-making. What is known about the topic? Despite increased community, media and research attention to end-of-life decision-making, resuscitation preferences of older patients are often poorly documented. Existing research into patient clinical and demographic factors that influence end-of-life decision-making have largely focused on general medical rather than psychogeriatric settings. There is a need to investigate rates of resuscitation documentation in psychogeriatric and general medical units and specific factors associated with having a ‘do not attempt resuscitation’ order in place, particularly the effect of current depression on decision-making. What does this paper add? Resuscitation orders were more frequently documented on the psychogeriatric than medical unit. Depression was not a significant predictor of resuscitation status in either group of patients. Although having undergone a competency assessment, older age and poorer prognosis predicted not being for resuscitation for the total sample, living in residential care and self-consenting to resuscitation status predicted not being for resuscitation for the overall sample and the medical group specifically. What are the implications for practitioners? This paper suggests that the need for clinicians to ensure documentation of preferences is a focus of day-to-day work with older patients. Clinicians should consider patient competency in end-of-life decision-making and how factors associated with depression, such as helplessness, may be more closely related to resuscitation decision-making in older patients.

During chest compressions action, in CPR (CPR), the 2 arms of the rescuer constitute a parallel mechanism. Inspired by this performance, during this study a specific family of lower mobility parallel manipulators by employing a modified version of Delta robot is proposed for chest compressions in rescuing a patient. One of the biggest differences between this mechanism and the Delta parallel mechanism is that the position of the three active connections of the robot relative to each other has changed the geometry of the platforms. Also, it shapes the asymmetrical structure within the robot mechanism and its workspace. Another difference is due to the architectural optimization method considering the mixed performance index, which has been used during this mechanism to achieve a much better compromise between the manipulator dexterity and its workspace. Within the present paper, after introducing the architecture of the robot, a closed-form solution is developed for the kinematic problem and therefore the results are verified using MSC. Adams©. Then Jacobian matrix is generated to gauge the singularity problem of the proposed mechanism. then, the workspace of the robot is investigated and compared with the original Delta mechanism.

The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training.This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training. The scenario included either a scripted paper or a phone call delivery of results concurrently with a clinical transition to pulseless ventricular tachycardia. Descriptive statistics and non-parametric tests were used to compare team performance before and after training.Performance from 40 teams was analyzed. Although the time taken to initiate CPR and defibrillation varied depending on the type of interruption and whether the scenario was before or after team training, these findings were not significantly associated with the leader's behaviour [Kruskal-Wallis test (p 0.05)]. An exact McNemar's test determined no statistically significant difference in the proportion of leaders involved or not in interpreting results between and after the training (exact p value = 0.096).Team training was successful in reducing time to perform key clinical tasks. Although team training modified the way leaders behaved toward the results, this behaviour change did not impact the time taken to start CPR or defibrillate. Further understanding the elements that influence time to critical clinical tasks provides guidance in designing future simulated educational activities, subsequently improving clinical team performance and patient outcomes.RéSUMé: BUT: L’acquisition et l’interprétation des résultats cliniques pendant les réanimations sont courantes; toutefois, cela peut retarder les tâches cliniques critiques, ce qui entraîne une augmentation de la morbidité et de la mortalité. Cette étude vise à déterminer l'impact de l'acquisition et de l'interprétation des résultats cliniques par le chef d'équipe sur la réalisation des tâches critiques lors d'un arrêt cardiaque pédiatrique simulé, avant et après la formation de l'équipe. MéTHODES: Il s'agit d'une analyse de données secondaires de scénarios de réanimation simulés enregistrés sur vidéo, réalisés au cours de l'étude Teams4Kids (T4K) (juin 2011-janvier 2015); les scénarios comprenaient un arrêt cardiaque avant et après la formation de l'équipe. Le scénario comprenait un document écrit ou un appel téléphonique donnant les résultats en même temps qu’une transition clinique vers la tachycardie ventriculaire sans pouls. Des statistiques descriptives et des tests non paramétriques ont été utilisés pour comparer le rendement de l’équipe avant et après la formation. RéSULTATS: Les performances de 40 équipes ont été analysées. Bien que le temps nécessaire au déclenchement de la RCP et de la défibrillation ait varié selon le type d'interruption et selon que le scénario se déroulait avant ou après la formation de l'équipe, ces résultats n'étaient pas significativement associés au comportement du leader [test de Kruskal-Wallis (p 0,05)]. Un test exact de McNemar n'a déterminé aucune différence statistiquement significative dans la proportion de dirigeants impliqués ou non dans l'interprétation des résultats entre et après la formation (valeur p exacte = 0,096). CONCLUSIONS: La formation en équipe a permis de réduire le temps nécessaire pour effectuer les tâches cliniques clés. Bien que la formation de l'équipe ait modifié le comportement des dirigeants vis-à-vis des résultats, ce changement de comportement n'a pas eu d’incidence sur le temps nécessaire pour commencer la RCP ou la défibrillation. Une meilleure compréhension des éléments qui influencent le temps consacré aux tâches cliniques critiques fournit une orientation pour la conception des futures activités éducatives simulées, améliorant par la suite le rendement des équipes cliniques et les résultats pour les patients.

Objective—To determine whether survival from out-of-hospital cardiac arrest is influenced by the on-scene availability of different grades of ambulance personnel and other health professionals. Design—Population based, retrospective, observational study. Setting—County of Nottinghamshire with a population of one million. Subjects—All 2094 patients who had resuscitation attempted by Nottinghamshire Ambulance Service crew from 1991 to 1994; study of 1547 patients whose arrest were of cardiac aetiology. Main outcome measures—Survival to hospital admission and survival to hospital discharge. Results—Overall survival from out-of-hospital cardiac arrest remains poor: 221 patients (14.3%) survived to reach hospital alive and only 94 (6.1%) survived to be discharged from hospital. Multivariate logistic regression analysis showed that the chances of those resuscitated by technician crew reaching hospital alive were poor but were greater when paramedic crew were either called to assist technicians or dealt with the arrest themselves (odds ratio 6.9 (95% confidence interval 3.92 to 26.61)). Compared to technician crew, survival to hospital discharge was only significantly improved with paramedic crew (3.55 (1.62 to 7.79)) and further improved when paramedics were assisted by either a health professional (9.91 (3.12 to 26.61)) or a medical practitioner (20.88 (6.72 to 64.94)). Conclusions—Survival from out-of-hospital cardiac arrest remains poor despite attendance at the scene of the arrest by ambulance crew and other health professionals. Patients resuscitated by a paramedic from out-of-hospital cardiac arrest caused by cardiac disease were more likely to survive to hospital discharge than when resuscitation was provided by an ambulance technician. Resuscitation by a paramedic assisted by a medical practitioner offers a patient the best chances of surviving the event. Keywords: out-of-hospital; cardiac arrest; paramedic; technician

A short cut review was carried out to establish whether metronomes can improve the quality of cardiopulmonary resuscitation. 38 papers were found using the reported searches, none of which directly addressed the problem but some 21 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated. It is concluded that the use of metronomes to guide the rate at which external chest compressions are delivered is associated with improved rates closer to those recommended in the current resuscitation guidelines.

Early cardiopulmonary resuscitation (CPR) is a strong link in the of survival for sudden cardiac arrest. Hence, bystander CPR (BPCR) plays an important role in curbing mortality and morbidity from out-of-hospital sudden cardiac arrest. However, the recent global Coronavirus disease 2019 (COVID-19) pandemic has impacted both public training and confidence in performing out-of-hospital CPR. This paper reviews detailed information from databases including Google Scholar, Scopus, PubMed and Web of Science on the readiness of BCPR during the pandemic. We also discussed the challenges bystanders encountered during the COVID-19 pandemic and the precautions to follow. Finally, we also highlighted the limitations which would benefit future endeavours in establishing well-planned and sustainable CPR training programs for the public. Therefore, regardless of the existing COVID-19 pandemic, BCPR must be emphasised to curb out-of-hospital cardiac arrest (OHCA) mortality.

WHAT IS KNOWN ON THE SUBJECT?: Discussion and documentation of a patient's resuscitation status are essential aspects of any hospital admission, and yet, they seldomly occur in psychiatry. Nurses play an important role in resuscitation status determination by being an information broker, supporter and advocate. Persons with mental illness may be competent to engage in the determination of their resuscitation status and deserve the same respect and autonomy as other patients during this process. There are no published qualitative studies exploring healthcare providers experiences in initiating resuscitation status conversations in the psychiatric setting. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An in-depth qualitative understanding of the complexity of resuscitation status determination in psychiatry. The shared experiences of nurses enacting their role in resuscitation status determination with patients admitted to psychiatry. The challenges of implementing a 'one-size fits all' approach to resuscitation status policies, and the ways in which depression and/or suicidal ideation influence the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Role clarity and improved communication between providers about resuscitation status determination in psychiatry are needed. Hospital policies for resuscitation status determination must account for the psychiatric context to ensure patients' goals of care are known and upheld. Nurses working in psychiatry should initiate and more readily engage in resuscitation status conversations. ABSTRACT: Introduction Patients with mental illness experience stigma and marginalization, which affects the quality of their health care. In most settings, end-of-life decisions, including goals of care, must be discussed with all patients upon hospital admission, including determining cardiopulmonary resuscitation preferences in the event of a medical emergency. Despite this requirement, these conversations do not routinely occur in inpatient psychiatry. By default, patients become a 'full code status', mandating life-sustaining interventions. Aim To explore how and why resuscitation status conversations occur, or do not occur, in inpatient psychiatry from the perspectives of healthcare providers. Method Qualitative descriptive study using focus groups with nurses working in psychiatry. Results Nurses' experiences with initiating and engaging in resuscitation status conversations related to Working in Psychiatry, which represents the current practices and the participants' views of the nursing role; Caring for Psychiatric Patients, which describes how fluctuating competency and suicidality influence determination; and The Influence of Physical Health Status, which details how differences in physical health status affect how healthcare providers engage in resuscitation status determination. Discussion Although the importance of completing resuscitation status conversations with patients admitted to psychiatry was expressed by participants, they seldomly occur. There is ambiguity about when and how to determine patient wishes. Implications for practice Tailored strategies are needed to ensure patients' rights to self-determination are upheld when they are admitted to psychiatry. Nurses working in this setting would benefit from education, training and support to adequately initiate and engage in these conversations.

Sudden cardiac death is a leading cause of death worldwide, whereby myocardial infarction is considered the most frequent underlying condition. Percutaneous coronary intervention (PCI) is an important component of post-resuscitation care, while uninterrupted high-quality chest compressions are key determinants in cardiopulmonary resuscitation (CPR). In our paper, we evaluate a case of a female patient who suffered aborted cardiac arrest due to myocardial infarction. The ambulance crew providing prehospital care for sudden cardiac arrest used a mechanical chest compression device during advanced CPR, which enabled them to deliver ongoing resuscitation during transfer to the PCI laboratory located 20 km away from the scene. Mechanical chest compressions were continued during the primary coronary intervention. The resuscitation, carried out for 2 h and 35 min, and the coronary intervention were successful, as evidenced by the return of spontaneous circulation and by the fact that, after a short rehabilitation, the patient was discharged home with a favorable neurological outcome. Our case can serve as an example for the effective and safe use of a mechanical compression device during primary coronary intervention.

Sudden cardiac death is a leading cause of death worldwide, whereby myocardial infarction is considered the most frequent underlying condition. Percutaneous coronary intervention (PCI) is an important component of post-resuscitation care, while uninterrupted high-quality chest compressions are key determinants in cardiopulmonary resuscitation (CPR). In our paper, we evaluate a case of a female patient who suffered aborted cardiac arrest due to myocardial infarction. The ambulance crew providing prehospital care for sudden cardiac arrest used a mechanical chest compression device during advanced CPR, which enabled them to deliver ongoing resuscitation during transfer to the PCI laboratory located 20 km away from the scene. Mechanical chest compressions were continued during the primary coronary intervention. The resuscitation, carried out for 2 h and 35 min, and the coronary intervention were successful, as evidenced by the return of spontaneous circulation and by the fact that, after a short rehabilitation, the patient was discharged home with a favorable neurological outcome. Our case can serve as an example for the effective and safe use of a mechanical compression device during primary coronary intervention.

Obxectivo: Moitas vítimas de vítimas mortais por afogamento son legos que intentan rescatar a outro. Esta revisión ten como obxectivo identificar as técnicas e os equipos máis seguros (mellorados ou fabricados a propósito) para que unha testemuña non adestrada os utilice cando intente un rescate acuático. Método: Tras a busca bibliográfica incluíuse unha mostra de 249 traballos, nos que finalmente se seleccionaron 19 seguindo a metodoloxía PRISMA e 3 procedementos de revisión por pares presentados en congresos internacionais. Engadíronse un total de 22 documentos á síntese cualitativa. Resultados: A situación xeográfica, o nivel económico, a condición física ou a experiencia poden variar o perfil dos socorristas legos e a forma de realizar un rescate acuático con seguridade. Identificáronse catro perfís de socorristas legos: 1) Nenos que rescatan nenos en países de ingresos baixos e medios (LMIC), 2) Adultos que rescatan a adultos ou nenos, 3) Legos con certa experiencia e formación en rescate, 4) Legos con motivacións culturais ou profesionais. Tres tipos de técnicas empregadas por estes perfís de socorristas legos: a) técnicas sen contacto para rescates desde terra: lanzamento e alcance, b) técnicas de rescate sen contacto mediante un dispositivo de flotación e, c) técnicas de contacto para o rescate na auga. Conclusión: A recomendación experta da técnica máis segura para un salvador lego é intentar o rescate usando un poste, corda ou equipo de flotación sen entrar na auga. Non obstante, a pesar das recomendacións de rescates sen contacto desde terra, existe unha tendencia global a tentar rescates por contacto na auga, a pesar de que non hai probas sobre a técnica, procedemento ou equipamento que contribúa a un rescate máis seguro. Deben considerarse estratexias de adestramento para profanos. Objective: Many victims of drowning fatalities are lay-people attempting to rescue another. This review aims to identify the safest techniques and equipment (improved or purpose made) for an untrained bystander to use when attempting a water rescue. Method: A sample of 249 papers were included after the bibliographic search, in which 19 were finally selected following PRISMA methodology and 3 peer review proceeding presented at international conferences. A total of 22 documents were added to qualitative synthesis. Results: Geographical location, economic level, physical fitness, or experience may vary the profile of the lay-rescuers and how to safely perform a water rescue. Four lay-rescuers profiles were identified: 1) Children rescuing children in low- and middle-income countries (LMICs), 2) Adults rescuing adults or children, 3) Lay-people with some experience and rescue training, 4) Lay-people with cultural or professional motivations. Three types of techniques used by those lay-rescuers profiles: a) non-contact techniques for rescues from land: throw and reach, b) non-contact techniques for rescue using a flotation device and, c) contact techniques for rescue into the water: swim and tow with or without fins. Conclusion: The expert recommendation of the safest technique for a lay-rescuer is to attempt rescue using a pole, rope, or flotation equipment without entering the water. However, despite the recommendations of non-contact rescues from land, there is a global tendency to attempt contact rescues in the water, despite a lack of evidence on which technique, procedure or equipment contributes to a safer rescue. Training strategies for lay-people should be considered. Financiado para publicación en acceso aberto: Universidade de Vigo/CISUG

Introduction Patients with transposition of the great arteries (ccTGA) and patients with transposition of the great arteries who had palliative surgery (Mustard/Senning procedures) often have progressive functional deterioration of the systemic right ventricle (sRV) and develop heart failure from the third or fourth decade of life.1 End stage heart failure requires an integrated approach and advance care planning (ACP)2 with ACHD cardiologists working alongside specialist heart failure and palliative care teams. We describe current practice with regards to ACP and palliative care referrals in patients with sRV at a tertiary referral centre. Methods Patients with ccTGA, Mustard or Senning procedures who were under active follow up from 2016 to 2021 were retrospectively analysed (n=122). Clinical and echocardiographic data were extracted from hospital electronic records and screened for factors which should prompt the consideration of palliative care referral and ACP as specified in prior guidance.2 These were; an episode of decompensation within 6 months despite optimal medical therapy, malignant arrhythmias, cardiac cachexia, frequent or continued intravenous therapies, poor quality of life (QoL), or progressive functional decline with dependence in activities of daily living and New York Heart Association (NYHA) IV symptoms. Results Baseline information is summarised in table 1. 7 patients had ACP (figure 1). 2 occurred during hospital admission in NYHA III patients with more than 1 episode of decompensation in 6 months despite optimal medical therapy, need for frequent intravenous therapy and chronic poor QoL. Cardiopulmonary resuscitation, implanted cardiac defibrillator deactivation and future care preferences were discussed. 5 patients had ACP as an outpatient who were NYHA I or II, which were patient initiated (n=3) and clinician initiated in response to progressive functional decline (n=1) and no identifiable prompt (n=1). 5 patients died during the data collection period (median age 41 years), 1 of which had advanced heart failure, discussed ACP and was referred to palliative care. 2 patients did not have ACP or palliative care input, however did meet the criteria for doing so (table 2). Conclusions In our cohort of patients with sRV, the majority of patients are NYHA class I and II with mild or moderately impaired sRV function. ACP occurred in 60% of patients with NYHA III symptoms. The timing of ACP or palliative care referral can be challenging due to the subjective under reporting of symptoms and risk of sudden death in this group. ACP discussions in the outpatient setting occurred irrespective of NYHA class severity and were mostly patient initiated. Early discussion is advocated in light of recent guidance3 recommending staged ACP to those who express an interest, or concurrently with planning interventions such as device implantation, heart transplant assessment, catheter interventions or cardiac surgery. Conflict of Interest None References Brida M, Diller GP, Gatzoulis MA. Systemic right ventricle in adults with congenital heart disease. Circulation 2018;137:508–518. Jaarsma T et al. Advanced heart failure study group of the HFA of the ESC. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2009;11(5):433–43 Schwerzmann M et al. Recommendations for advance care planning in adults with congenital heart disease: a position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD). European Heart Journal 2020;41(43):4200–4210.

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

The dilemma of whether to allow relatives to see or even touch their loved one while she undergoes cardiopulmonary resuscitation (CPR) has been discussed for roughly four decades. However, Family Presence During Adult Resuscitation (FPDR) is still not widely implemented. In this paper, I espouse relational autonomy to make a case for a clinical approach of family-centered care and FPDR. In recent years, family-centered care (FCC) has gained increasing support. I argue that relational autonomy provides a conceptual framework for both FCC and FPDR. In turn, FCC provides a plausible clinical approach to justify FPDR, while the empirical evidence that supports FPDR provides a useful example to justify FCC.

Purpose The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month. Design/methodology/approach The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance. Findings There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment. Originality/value Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

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

Immediate witnesses of out-of-hospital cardiac arrest (OHCA) play the leading role in supporting human life. In cases when basic cardiopulmonary resuscitation (CPR) is not performed by the bystanders, precipitous hypoxia brings chances for recovery almost to zero by the time of emergency medical services (EMS) arrival. Carrying out CPR following the instructions given by EMS dispatcher over the telephone (T-CPR) is the fastest and most efficient way of increasing bystander CPR rates. Implementation of T-CPR programs is proved to increase survival from OHCA. Consequently, T-CPR is defined by the effective guidelines for resuscitation as an essential component of pre-hospital care. This review discusses the modern approaches to organizing and implementing T-CPR programs, as well as potential barriers and international experience of T-CPR implementation. The paper is meant for EMS directors and managers, EMS dispatchers and public health specialists.

Recurrent myocarditis is rare with only few reports having been published for paediatric cases. Repeated use of extracorporeal membrane oxygenation is also uncommon. In this paper we will present a very rare case of a 7-year old girl with recurrent fulminant myocarditis with heart failure requiring cardiopulmonary resuscitation and mechanical circulatory support with extracorporeal membrane oxygenation. Both episodes were precipitated by a viral upper respiratory tract infection, and in both cases the cardiac function eventually completely recovered. The second episode of fulminant myocarditis was particularly complex with markedly elevated markers of myocardiocytolysis, multiorgan dysfunction and the need for prolonged mechanical circulatory support. Nevertheless, the patient made a remarkable recovery. A comprehensive diagnostic workup pointed towards an aberrant immune response as the likely cause of the girl’s susceptibility for fulminant myocarditis.

Do not attempt cardiopulmonary resuscitation decisions (DNACPR) are considered good medical practice for those dying at the end of natural life. They avoid intrusive and inappropriate intervention. Historically, informing patients of these decisions was discretionary to avoid undue distress. Recent legal rulings have altered clinical guidance: disclosure is now all but obligatory. The basis for these legal judgments was respect for the patient's autonomy as an expression of their human rights. Through critical analysis, this paper explores other bioethical considerations and the potential harms if they are ignored. Arguably, disclosure of DNACPR status on its own will do little to improve patient experience. A focus on good communication with those identified as approaching end-of-life will facilitate personalized care. Discussions around DNACPR may still occur, but only if likely to be beneficial and at a patient-appropriate pace (not dictated by the need to activate the decision).

This short review addresses the evidence behind dispatcher-assisted CPR (DA-CPR) and whether it contributes to overall survival of out-of-hospital cardiac arrest (OHCA). Six papers directly addressed the review question and were selected for appraisal, including one systematic review. The outcomes of these studies demonstrate variable results from the implementation of DA-CPR strategies. While DA-CPR has some utility as a substitute for spontaneously delivered bystander CPR, available evidence suggests there is scope to improve. Further work should focus on the identification and adoption of more effective protocols.

Background: Increasing attention to care of patient succumbed to out-of-hospital cardiac arrest (OHCA) and evidence for improved survival have resulted in many countries to encourage the use automated external defibrillators (AEDs) by legislation. In Taiwan, the amendment of the Emergency Medical Services Act mandated the installation of AEDs in designated areas in 2013. Since then, 6151 AEDs have been installed and registered in mandated and non-mandated locations. The purpose of this study was to investigate the utilization of AEDs at mandated and non-mandated locations. Methods: This paper analyzed 217 cases in whom AEDs was used between July 11, 2013 and July 31, 2015. Descriptive statistics were used to analyze the data. Results: The highest frequency of AEDs used was in long-term care facilities, accounting for 34 (15.7%) cases. The second and third highest was in schools and commuting stations. The highest utilization rate of registered AED was in long-term care facilities (73.9%), the second was in residential areas, and the third was in hot spring areas. Employees at the designated locations or medical personnel operated the AED in 143 cases (84.6%), and bystanders, relatives, friends or others operated the AEDs in 26 cases (15.4%). On-site Return of Spontaneous Circulation (ROSC) after applying AEDs occurred in 76 cases (45.8%). Conclusion: Long-term care facilities had the highest utilization of AEDs and government should pay more attention to enforce the installing of AEDs in these places. The government also needs to promote the education public on how to search the AEDs locations. Keywords: AED, Location, ROSC, Usage rate

Introduction/Objective. Clarifying cases involving suspicious natural death and all forensic problems connected to such cases is possible only with the aid of a timely and adequately performed autopsy. The objective of this paper, however, is to point out the fact that it is possible to prove the existence of a physician?s error, even when an autopsy had not been performed. Case report. The Emergency Medical Service (EMS) team had been dispatched to respond to a call for help by a 53-year-old woman, complaining of chest pain, shortness of breath, and dizziness. The pain was located in the center of her chest and would increase in response to palpation, change of body position, and deep breathing. The physical examination was normal. The EMS physician concluded that it was not necessary to perform electrocardiography (ECG). Forty minutes later, the EMS team was dispatched to see the same patient again, this time for suspected cardiac arrest. Protocol-based cardiopulmonary resuscitation (CPR) for asystole was performed, without success. After 30 minutes, CPR was discontinued and the patient was declared deceased. Although the patient?s relatives did not allow an autopsy to be performed, they did send a claim to the Health Inspector at the Ministry of Health of Serbia, demanding an internal review of the physician?s professional work. It was concluded that the physician should have performed ECG, but that the true cause of death could only have been determined through a timely and adequately performed autopsy. Conclusion. An unperformed autopsy does not exclude the possibility of proving a physician?s error.

Patient mortality at one year reaches 90% after out-of-hospital cardiac arrest and resuscitation. Temperature management is one of the main strategies proposed to improve patient outcome after resuscitation and preclinical studies have shown neuroprotective effects when hypothermia is achieved rapidly, although the underlying mechanisms have not yet been elucidated. State-of-the-art brain imaging technologies can bring new insights into the early cerebral events taking place post cardiac arrest and resuscitation. In this paper, we characterized cerebral hemodynamics in a post-cardiac arrest rabbit model using functional ultrasound imaging. Ultrasound datasets were processed to map the dynamic changes in cerebral blood flow and cerebral vascular resistivity with a 10 second repetition rate while animals underwent cardiac arrest and a cardiopulmonary resuscitation. We report that a severe transient hyperemia takes place in the brain within the first twenty minutes post resuscitation, emphasizing the need for fast post-cardiac arrest care. Furthermore, we observed that this early hyperemic event is not spatially homogeneous and that maximal cerebral hyperemia happens in the hippocampus. Finally, we show that rapid cooling induced by total liquid ventilation reduces early cerebral hyperemia, which could explain the improved neurological outcome reported in preclinical studies.

Introduction The Global Resuscitation Alliance (GRA) was established in 2015 to improve survival for Out- of-Hospital Cardiac Arrest (OHCA) using the best practices developed by the Seattle Resuscitation Academy. However, these 10 programs were recommended in the context of developed Emergency Care Systems (ECS). Implementing these programs can be challenging for ECS at earlier stages of development. We aimed to explore barriers faced by developing ECS and to establish pre-requisites needed. We also developed a framework by which developing ECS may use to build their emergency response capability. Method A consensus meeting was held in Singapore on 1st–2nd August 2017. The 74 participants were key stakeholders from 26 countries, including Emergency Medical Services (EMS) directors, physicians and academics, and two Physicians who sit on the World Health Organisation (WHO) panel for development of Emergency Care Systems. Five discussion groups examined the chain of survival: community, dispatch, ambulance and hospital; a separate group considered perinatal resuscitation. Discussion points were voted upon to reach a consensus. Results The answers and discussion points from each groupwere classified into a table adapted from WHO’s framework of development for Emergency Services. After which, it was used to construct the modified survival framework with the chain of survival as the backbone. Eleven key statements were then derived to describe the pre-requisites for achieving the GRA 10 programs. The participants eventually voted on the importance and feasibility of these 11 statements as well as the GRA 10 programs using a matrix that is used by organisations to prioritise their action steps. Conclusion In this paper, we propose a modified framework of survival for developing ECS systems. There are barriers for developing ECS systems to improve OHCA survival rates. These barriers may be overcome by systematic prioritisation and cost-effective innovative solutions.

Background Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR. Methods In a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic. Results While 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies. Conclusions Members of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00841-1.

Background: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest. Methods: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2 nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes. Results: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7% to 8.0%) and 2.1% specific (95% CI 0.8–4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4–26.4%) and 50.7% (95% CI 45.8–55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2–15.5%) and 20.1% (95% CI 16.2–24.3%), respectively. Conclusions: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary.

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging concept in cardiac arrest and cardiopulmonary resuscitation. Recent research has documented a significant improvement in favorable outcomes, notable survival to discharge, and neurologically intact survival. Objectives The present study undertakes a scoping review to summarize the available evidence by assessing the use of ECPR, compared with no ECPR or the standard of care, for adult patients who sustain cardiac arrest in any setting, in studies which record survival and neurologic outcomes. Methods This review followed the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Four online databases were used to identify papers published from database inception to July 12, 2020. We selected 23 observational studies from Asia, Europe, and North America that used survival to discharge or neurologically intact survival as a primary or secondary endpoint variable in patients with cardiac arrest refractory to standard treatment. Results Twenty-three observational studies were included in the review. Eleven studies were of out-of-hospital cardiac arrest, 7 studies were of in-hospital cardiac arrest, and 5 studies included mixed populations. Ten studies reported long-term favorable neurological outcomes (ie, Cerebral Performance Category score of 1 - 2 at 3 months [n = 3], 6 months [n = 3], and 1 year [n = 4]), of which only 4 had statistical significance at 5% significance levels. Current knowledge is mostly drawn from single-center observations, with most of the evidence coming from case series and cohort studies, hence is prone to publication bias. No randomized control trials were included. Conclusions This scoping review highlights the need for high-quality studies to increase the level of evidence and reduce knowledge gaps to change the paradigm of care for patients with shock-refractory cardiac arrest.

Recently, a smart-device-based chest compression depth (CCD) feedback system that helps ensure that chest compressions have adequate depth during cardiopulmonary resuscitation (CPR) was developed. However, no CCD feedback device has been developed for infants, and many feedback systems are inconvenient to use. In this paper, we report the development of a smart-ring-based CCD feedback device for CPR based on an inertial measurement unit, and propose a high-quality chest compression depth estimation algorithm that considers the orientation of the device. The performance of the proposed feedback system was evaluated by comparing it with a linear variable differential transformer in three CPR situations. The experimental results showed compression depth errors of 2.0 ± 1.1, 2.2 ± 0.9, and 1.4 ± 1.1 mm in the three situations. In addition, we conducted a pilot test with an adult/infant mannequin. The results of the experiments show that the proposed smart-ring-based CCD feedback system is applicable to various chest compression methods based on real CPR situations.

Introduction: Survival rates for patients in out-of-hospital cardiac arrest have remained around 10% in the United Kingdom for the past seven years. If outcomes are to be improved, research into new methods of advanced life support is required. One such method may be ‘heads-up’ cardiopulmonary resuscitation.Methods: A systematic review of literature exploring heads-up cardiopulmonary resuscitation was conducted in an attempt to identify its effects on survival to discharge and neurological outcome.Results: A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Six papers were classed as sufficiently relevant for inclusion. Included studies were generally of low quality and none studied the effect of heads-up cardiopulmonary resuscitation on out-of-hospital cardiac arrest patients. Animal studies identified a significant reduction in intracranial pressure and increase in cerebral and coronary perfusion pressure for use of augmented heads-up cardiopulmonary resuscitation in the porcine model of cardiac arrest.Conclusion: Further research is required to analyse the effects and potential benefits of augmented heads-up cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

The diploma thesis offers an insight into the issues of first aid. The theoretical part describes the history of first aid, its legal basis and the distribution of first aid. Furthermore, the thesis describes the general procedure for providing first aid, the principles of safety in providing first aid and basic examination of the affected person's health are mentioned. The next chapter of this paper is devoted to dangerous injuries and conditions and their treatment. This chapter is followed by a description and solution to an emergency with a large number of injured. For psychological support is often needed at the scene of an emergency, a chapter on first psychological assistance is added into the thesis. The last chapters of the thesis are devoted to the Fire Rescue Service of the Czech Republic and the Police of the Czech Republic. The research part of the diploma thesis defines the methods and goals of own research and the results, which are then discussed in the discussion. The main goal of the thesis was to find out whether members of the Fire Rescue Service of the South Bohemian Region and members of the Police of the Czech Republic in the South Bohemian Region have sufficient knowledge in the field of first aid at the scene of an emergency. Part of this goal was also to answer research questions: Does the knowledge of members of the Fire Rescue Service of the South Bohemian Region reach 90% in the given issue? Does the knowledge of members of the Police of the Czech Republic in the South Bohemian Region reach the same level as the knowledge of members of the Fire Rescue Service of the South Bohemian Region in the given issue? To determine this information, a questionnaire survey was used, in which a total of 125 members of the surveyed units participated. The research has revealed that the knowledge of members of the Fire Rescue Service of the South Bohemian Region does not reach the necessary limits and is therefore low. The knowledge of members of the Police of the Czech Republic in the South Bohemian Region reaches a lower level than the knowledge of members of the Fire Rescue Service of the South Bohemian Region.

With the increase in heart disease and frequent heart attacks, the death rate has increased in a terrifying and appalling manner worldwide due to the lack of first aid practices such as cardiopulmonary resuscitation (CPR). Cardiopulmonary resuscitation is a dual process in which the paramedic resuscitates the lung and heart. As for resuscitation of the lung, it is through the delivery of air and oxygen to it through artificial respiration, as for reviving the heart, it is accomplished through manual pressure on the area of the injured heart “in the area between the thoracic bone and the spine” so that blood is pumped to human vital organs of the injured person’s body, especially the brain. This paper involves designing a manikin that interacts with humans to facilitate the application of CPR in a correct and scientific form by measuring the strength and depth of pressure and calculating the number of compression per minute (CPM). The system control architecture is based on IoT concept where data that is read from integrated sensors and sent to IoT hubs such as Amazon Web Services. The purpose of this work is to provide trainees with a training tool on resuscitation approaches.

Numerous iatrophysicists and iatrochemists were experimenting with the effects of external forces on morphological and physiological processes, including the influence of electricity on animal and human organisms. They specifically investigated the effects on muscular activity, circulation, and nervous system, and their works served as a basis for the subsequent use of electricity in diagnosis and treatment, as well as in cardiocirculatory resuscitation. Valuable historical review papers have been published on the use of electrotherapy in the treatment of cardiac arrhythmia, cardiac arrest, and sudden death. Noticeable scientific and professional work in medical electrotherapy was performed by Joseph Francis Domin (1754–1819). Domin was a scientist of Croatian origin, who lived in the Habsburg Monarchy in the period of Enlightenment and a rapid development of natural science. As a philosopher, theologist, and natural scientist, Domin was appointed professor of theoretical and experimental physics, mechanics, and chemistry at the Royal Academies in Győr and Pecs, as well as professor of physics at the Faculty of Philosophy of the University of Pest, where he also served as Dean. Domin wrote several works in Latin on the use of electricity in medical treatments based on his own experiences. In these works, he described the beneficial ef fects of electricity on the treatment of paresis, rheumatism, headache, epilepsy, podagra, febrile conditions in children and adults, hearing loss, neuralgia, and resuscitation after asphyxia. Here, we present our English translation of Domin’s description of simultaneous resuscitation procedure with static electricity and oxygenation. This was the first text on that topic in the scientific literature of that time. This text allows new insights into the treatment of cardiac arrest at the end of the 18th century – one century before the first proven use of electrotherapy in clinical human resuscitation.

A short-cut review was carried out to establish whether prehospital adrenaline affects long-term morbidity or mortality after out-of-hospital cardiac arrest. Fifty-five papers were found using the reported search. Of these, three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that while epinephrine used as an adjunctive treatment during out-of-hospital cardiac arrest (OHCA) may improve return of spontaneous circulation (ROSC) and survival to hospital, it does not improve survival to discharge or neurological outcome.

Background The optimal time to save a person who has had a sudden cardiac arrest is within the first few minutes of the incident. Early compression and early defibrillation should be performed at this time. Timeliness is the key to successful CPR; as such, Prof. He proposed the “platinum 10 min” system to study early CPR issues. This paper systematically evaluates the success rates of heartbeat restoration within the “platinum 10 min” among patients suffering from sudden cardiac arrest. Methods The clinical data of outpatients suffering from a cardiac arrest were retrieved from the China Knowledge Network (January 1975–January 2015), the Chongqing VIP database (January 1989–January 2015), and the Wanfang database (January 1990–January 2015). The success of the cardiopulmonary resuscitation (CPR) performed at different times after the patients had cardiac arrests was analyzed. Two researchers screened the literature and extracted the data independently. A meta-analysis was conducted using Stata12.0. A total of 57 papers met the inclusion criteria, including 29,269 patients. Of these patients, 1776 had their heartbeats successfully restored. The results showed high heterogeneity (X2 = 3428.85, P 15 min group. The CPR success rates of these five groups were 0.247 (0.15–0.344), 0.353 (0.250–0.456), 0.136 (0.109–0.163), 0.058 (0.041–0.075), and 0.011 (0.004–0.019), respectively. The CPR success rates did not differ between the patients in the ≤1 min group and the 1- ≤ 5 min group. This success rate was higher for the patients in the 1- ≤ 5 min group than those in the 10- ≤ 15 min group, those in the 10- ≤ 15 min group, and those in the >15 min group. The CPR success rate was higher for the patients in the 5-10 min group than those in the 10- ≤ 15 min group and those in the >15 min group. Conclusions The CPR success rate was higher for the patients in the 10- ≤ 15 min group than those in the >15 min group. In addition, the patients were divided into two groups based on whether CPR was performed within the first 10 min after the cardiac arrest occurred: the ≤10 min group and the >10 min group. The CPR success rate was higher for the patients in the ≤10 min group (0.189 [0.161–0.218]) than those in the >10 min group (0.044 [0.032–0.056]). (3) Differences were not found between the CPR success rates among the patients in the telephone guidance group (0.167 [0.016–0.351]) and those in the ≤1 min, 1- ≤ 5 min, 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. (4) The CPR success rates did not differ among in the patients in the witness + public group (0.329 [0.221–0.436]), those in the ≤1 min group, and those in the 1- ≤ 5 min group. However, this success rate was higher in the patients in the witness + public group than those in the 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. Conclusions The success rate of heartbeat restoration did not differ among patients receiving CPR based on different guidelines. The success rate of CPR lies in its timeliness. The participation of the general population is the cornerstone of improving CPR. Providing complete emergency treatment equipment and perfecting comprehensive measures can improve the success rate of CPR among patients within the platinum 10 min. CPR research in China must be improved.

INTRODUCTION Sudden cardiac arrest is one of the leading causes of death in Europe and the whole world. Effective chest compressions and advanced airway management have been shown to improve survival rates. Supraglottic airway devices such as the laryngeal tube (LT) are a well-known strategy for patients with cardiac arrest during both basic (BLS) and advanced life support (ALS). This systematic literature review aimed to summarize current data for using the LT when performing BLS and ALS. EVIDENCE ACQUISITION Recent data on the use of the LT during cardiopulmonary resuscitation (CPR) was gathered by using the Medline database and a specific search strategy. Terms were used in various order and combinations without time restrictions. A total of N.=1005 studies were identified and screened by two experienced anesthesiologists/emergency physicians independently. Altogether, data of N.=19 relevant papers were identified and included in the analysis. EVIDENCE SYNTHESIS Using the LT showed fast and easy placement with high success rates (76% to 94%) and was associated with higher short-term survival as compared to other strategies for initial airway management (2.2% vs. 1.4%). Quality of CPR such as chest compression fraction (CCF) before and after LT-insertion is improved (75% vs. 59%). For long-term survival, the LT showed lower survival rates. CONCLUSIONS Especially as initial device of airway management (for inexperienced staff), the use of a LT is easy and results in a fast insertion. The advantages of the LT as compared to bag mask ventilation and endotracheal intubation are inhomogeneous in recent literature.

Emergency medical care for critically ill nontrauma patients (CINT) varies between different emergency departments (ED) and healthcare systems, while resuscitation of trauma patients is always performed within the ED. In many ED CINT are treated and stabilized while in many German smaller hospitals CINT are transferred directly to the intensive care unit (ICU) without performing critical care measures in the ED. Little is known about the resuscitation room management of CINT regarding patient characteristics and outcome although bigger hospitals perform ED resuscitation of CINT in routine care. Against this background we conducted this retrospective analysis of CINT treated by an ED resuscitation room concept in a German 756 bed teaching hospital.The collective of CINT treated within the ED resuscitation room (1 October 2018 to 31 March 2019) was analyzed after ethical approval. After each resuscitation room operation, the team leader filled out a standardized paper-based questionnaire and qualified the patient as a resuscitation room patient this way. Only patients who underwent invasive procedures and were admitted to ICU or died in the ED were included. Patient characteristics, performed critical care measures, short-term outcomes and the comparison of admission characteristics between survivors and non-survivors were evaluated. Additionally, the accordance of ED admission diagnoses and discharge diagnoses were analyzed.Overall, 243 of 19,854 ED patients (1.22%) were treated in the resuscitation room. After exclusion of trauma patients, 193 (0.97%) CINT were included. Overall mortality was 29% (n = 56), 24‑h mortality was 13% (n = 25). Patient characteristics (vital signs, blood gas analysis) differed significantly between survivors and nonsurvivors except for respiratory rate and pain scale. An excerpt of conducted resuscitation room measures was as follows: arterial line n = 78 (40%); noninvasive ventilation n = 60 (31%); endotracheal intubation n = 56 (29%); cardiopulmonary resuscitation n = 19 (10%), central venous line n = 8 (4%). The number of conducted measures differed between survivors and nonsurvivors (median and interquartile range, IQR): 4 (IQR 2) vs. 4 (IQR 3) p = 0.0453. The length of ED stay was 148.2 ± 202.7 min until the patient was admitted to an ICU or died within the ED. ED admission diagnoses matched with hospital discharge diagnoses in 78%.The observed mortality was high and was comparable to patient collectives with septic shock. Nonsurvivors showed significantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis might enable ED risk stratification of CINT. Resuscitation room management enables immediate stabilization and diagnostic work-up of CINT even when no ICU bed is available. Furthermore, optimal allocation to specialized ICUs can probably be enabled more accurately after a first diagnostic work-up; however, although a first diagnostic work-up including laboratory tests and computed tomography in many cases was performed, ED admission and hospital discharge diagnoses matched only in 78%.EINLEITUNG: Die Notfallversorgung für kritische Kranke ist in verschiedenen Gesundheitssystemen heterogen organisiert. Während Traumapatienten immer im Schockraum übergeben und stabilisiert werden, erfolgt speziell in der deutschen Grund- und Regelversorgung bei kritisch kranken Nicht-Traumapatienten häufig eine direkte Aufnahme auf die Intensivstation durch den Rettungsdienst. In dieser retrospektiven Studie wurde daher die Schockraumversorgung nichttraumatologischer Patienten in einem 756-Betten-Lehrkrankenhaus analysiert.Schockraumversorgungen kritisch Kranker (01.10.2018 bis 31.03.2019) wurden in Bezug auf Patientencharakteristika, durchgeführte Schockraummaßnahmen und Krankenhaussterblichkeit analysiert. Ferner sollten die Aufnahmecharakteristika zwischen Überlebenden und Nichtüberlebenden evaluiert werden. Aufnahme- und Entlassungsdiagnosen sollten vergleichend ausgewertet werden.Es wurden 243/19.854 Patienten (1,22 %) im Untersuchungszeitraum als Schockraumpatienten behandelt. Nach Ausschluss von Traumapatienten konnten 193 (0,97 %) kritisch kranke nichttraumatologische Patienten eingeschlossen werden. Die Gesamtsterblichkeit lag bei 29 % (n = 56), die 24-h-Sterblichkeit bei 13 % (n = 25). Es wurden im Mittel 4,24 Schockraummaßnahmen (z. B. Intubation, Zentraler Venenkatheter) durchgeführt mit einer Versorgungsdauer in der Notaufnahme von 148 ± 203 min. Die Aufnahmeparameter von Überlebenden und Nichtüberlebenden unterschieden sich signifikant mit Ausnahme von Atemfrequenz und Schmerzskala. Durchgeführte Schockraummaßnahmen bei Überlebenden vs. Nichtüberlebenden: Median 4 (IQR 2) vs. 4 (IQR 3), p = 0,0453. Krankenhausaufnahme- und Entlassungsdiagnosen stimmten in 78 % der Fälle überein.Bei insgesamt hoher Krankenhaussterblichkeit zeigten sich signifikant schlechtere Vital- und Blutgasanalyseparameter bei Aufnahme für das Subkollektiv der Nichtüberlebenden. Ein möglicher Score aus Vital- und Blutgaswerten könnte folglich eine zukünftige Risikostratifizierung für nichttraumatologische Schockraumpatienten ermöglichen. Die nichttraumatologische Schockraumversorgung ermöglicht eine sofortige notfallmedizinische Versorgung und genaue Patientenallokation zu spezialisierten Intensivstationen. Nichtsdestotrotz stimmten Krankenhausaufnahme- und Entlassungsdiagnosen in 78 % überein.

AimThe AIRWAYS-2 cluster randomised controlled trial compared the i-gel supraglottic airway device (SGA) with tracheal intubation (TI) as the first advanced airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months.MethodsParamedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods.Results767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings.ConclusionThere were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months.

Background: Bystander actions upon witnessing a cardiac arrest are crucial to improving patient survival. Bystander perceptions and actions when witnessing a cardiac arrest are complex and not well understood. Our study has three primary aims: 1) To characterize CA bystanders demographics, 2) To understand the events from patient collapse until EMS arrival, with a focus on telecommunicator or dispatcher-assisted CPR (T-CPR), and 3) Bystander knowledge/ training in CPR and their actions at the time of CA. Methods: This is a prospective observational study conducted on bystanders of out of hospital cardiac arrests (OHCA) serviced by EMS agencies in southeast Michigan. OHCA patients were identified from 3/2018- 12/2019, and bystanders of these events surveyed. Surveys were mailed to non-medical addresses with an introductory letter and paper survey. A phone interview was conducted to describe bystander demographics, events from collapse to EMS arrival, and their actions including CPR performance. We inquired regarding telecommunicator CPR instructions (T-CPR), and if CPR was not performed what were the barriers. Results: During our study period, 126 surveys were mailed, and of these 47 bystander surveys were completed. The majority of events occurred in private homes (37/47,78.7%). Few patients (10, 21.2%) survived to discharge. The bystander and patient age were (mean, range)were 62.9 (30-91 ) and 69.3 (30-100) respectively. The majority were female 27/47(57.4%), most 43/47 (91.4%) knew the patient and were family (34/47,72.3%). Bystanders knew the patient a median(range) of 32 (0-68) years. A majority of bystanders (31/47,66.0%) had CPR training and 19 performed CPR. Of the 14/47 (27.8%) that received T-CPR instructions, 9 performed CPR. CPR trained bystanders that did not perform CPR(8/31), identified panic, assessment barriers and physical reasons for not performing CPR. Conclusion: In this preliminary work, we identify that bystanders to OHCA are most often family, of similar age to the patient and knew the patient for decades. CPR educational programs should prepare trainees to know that they may well respond to loved ones. Further researcher characterizing bystanders and their actions are needed to improve cardiac arrest outcomes.

The provided database of 260 ECG signals was collected from patients with out-of-hospital cardiac arrest while treated by the emergency medical services. Each ECG signal contains a 9 second waveform showing ventricular fibrillation, followed by 1 min of post-shock waveform. Patients’ ECGs are made available in multiple formats. All ECGs recorded during the prehospital treatment are provided in PFD files, after being anonymized, printed in paper, and scanned. For each ECG, the dataset also includes the whole digitized waveform (9 s pre- and 1 min post-shock each) and numerous features in temporal and frequency domain extracted from the 9 s episode immediately prior to the first defibrillation shock. Based on the shock outcome, each ECG file has been annotated by three expert cardiologists, - using majority decision -, as successful (56 cases), unsuccessful (195 cases), or indeterminable (9 cases). The code for preprocessing, for feature extraction, and for limiting the investigation to different temporal intervals before the shock is also provided. These data could be reused to design algorithms to predict shock outcome based on ventricular fibrillation analysis, with the goal to optimize the defibrillation strategy (immediate defibrillation versus cardiopulmonary resuscitation and/or drug administration) for enhancing resuscitation.

Background and objectiveVirtual reality (VR) and augmented reality (AR) have been proposed as novel methods to enhance cardio-pulmonary resuscitation (CPR) performance and increase engagement with CPR training. A scoping review was conducted to map the global evolution of these new approaches to CPR training, to assess their efficacy and determine future directions to meet gaps in current knowledge.MethodsA standardised five-stage scoping methodology was used to (1) identify the research question, (2) identify relevant studies, (3) select the studies, (4) chart the data and (5) summarise the findings. The Kirkpatrick model levels of evidence were used to chart and assess the efficacy of each intervention reported. A multi-pronged search term strategy was used to search the Web of Science, PubMed, CINAHL and EMBASE databases up to June 2020.ResultsA total of 42 articles were included in this review. The first relevant paper identified was published in 2009 and based on VR, from 2014 onwards there was a large increase in the volume of work being published regarding VR and AR uses in CPR training. This review reports Kirkpatrick level one to three evidence for the use of VR/AR–CPR. Inconsistencies in the specific language, keywords used and methodologies are highlighted.ConclusionVR and AR technologies have shown great potential in the area of CPR, and there is continuing evidence of new novel applications and concepts. As VR/AR research into CPR reaches an inflection point, it is key to bring collaboration and consistency to the wider research community, to enable the growth of the area and ease of access to the wider medical community.

Background: To date, targeted temperature management (TTM) is the only neuroprotective intervention after resuscitation from cardiac arrest that is recommended by guidelines. The evidence on the effects of TTM is unclear. Methods/design: The Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest (TTM2) trial is an international, multicentre, parallel group, investigator-initiated, randomised, superiority trial in which TTM with a target temperature of 33 °C after cardiac arrest will be compared with a strategy to maintain normothermia and active treatment of fever (≥ 37.8 °C). Prognosticators, outcome assessors, the steering group, the trial coordinating team, and trial statisticians will be blinded to treatment allocation. The primary outcome will be all-cause mortality at 180 days after randomisation. We estimate a 55% mortality in the targeted normothermia group. To detect an absolute risk reduction of 7.5% with an alpha of 0.05 and 90% power, 1900 participants will be enrolled. The secondary neurological outcome will be poor functional outcome (modified Rankin scale 4-6) at 180 days after cardiac arrest. In this paper, a detailed statistical analysis plan is presented, including a comprehensive description of the statistical analyses, handling of missing data, and assessments of underlying statistical assumptions. Final analyses will be conducted independently by two qualified statisticians following the present plan. Discussion: This SAP, which was prepared before completion of enrolment, should increase the validity of the TTM trial by mitigation of analysis-bias., SCOPUS: ar.j, info:eu-repo/semantics/published

The aim of the study was to assess the usefulness of the Glasgow Coma Scale (GCS) score assessed by EMS team in predicting survival to hospital discharge in patients after out-of-hospital cardiac arrest (OHCA).Silesian Registry of OHCA (SIL-OHCA) is a prospective, population-based regional registry of OHCAs. All cases of OHCAs between the 1st of January 2018 and the 31st of December 2018 were included. Data were collected by EMS using a paper-based, Utstein-style form. OHCA patients aged ≥18 years, with CPR attempted or continued by EMS, who survived to hospital admission, were included in the current analysis. Patients who did not achieve return of spontaneous circulation (ROSC) in the field, with missing data on GCS after ROSC or survival status at discharge were excluded from the study.Two hundred eighteen patients with OHCA, who achieved ROSC, were included in the present analysis. ROC analysis revealed GCS = 4 as a cut-off value in predicting survival to discharge (AUC 0.735; 95%CI 0.655-0.816; p 0.001). Variables significantly associated with in-hospital survival were young age, short response time, witnessed event, previous myocardial infarction, chest pain before OHCA, initial shockable rhythm, coronary angiography, and GCS 4. On the other hand, epinephrine administration, intubation, the need for dispatching two ambulances, and/or a physician-staffed ambulance were associated with a worse prognosis. Multivariable logistic regression analysis revealed GCS 4 as an independent predictor of in-hospital survival after OHCA (OR of 6.4; 95% CI 2.0-20.3; p 0.0001). Other independent predictors of survival were the lack of epinephrine administration, previous myocardial infarction, coronary angiography, and the patient's age.The survival to hospital discharge after OHCA could be predicted by the GCS score on hospital admission.

Poznavanje osnovnih postupaka održavanja života (BLS) predstavlja suštinu djelatnosti medicinskog osoblja. Činjenica je da stručnost, uvježbanost i znanje tih postupaka proizlazi iz dobrog bazičnog poznavanja teorije o postupcima BLS-a, kao i kontinuiranog uvježbavanja istih. U ovom završnom radu upoznati ćemo se s postupcima BLS-a i najnovijim smjernicama u provođenju istih. Koristeći informacije prikupljene putem anketnog upitnika, procijeniti ćemo razinu poznavanja postupaka BLS-a kod medicinskih sestara i tehničara. Anketni upitnik „Poznavanje postupaka BLS-a kod medicinskih sestara/tehničara“ sastojao se od 5 pitanja vezana uz sociodemografske podatke: dob, spol, stupanj obrazovanja, radno mjesto te radno iskustvo. Ostatak anketnog upitnika sastojao se od 12 pitanja vezanih uz postupke BLS-a u kojima su ispitanici trebali odabrati točan odgovor među ponuđenim tvrdnjama. Dobiveni rezultati potvrditi će postoji li statistički značajna povezanost između razine poznavanja postupaka BLS-a i stupnja obrazovanja, djelatnosti u struci te radnog iskustva ispitanika. Od medicinskih djelatnika očekuje se da postupke BLS- a dobro poznaju te da su dobro uvježbani za njihovo izvođenje. Cilj je u budućnosti prepoznati potrebu za češćim ponavljanjem postupaka BLS-a (osobito u onim službama koje se rijetko susreću sa srčanim zastojem) što bi u konačnici stvorilo podlogu za poboljšanje preživljavanja i boljeg ishoda post reanimacijskog perioda među osobama koje su doživjele srčani zastoj. Knowledge of basic life support procedures (BLS) is the work essence of medical staff. The fact is that the expertise, training and knowledge of those procedures, stems from a good basic knowledge of the theory of BLS, as well as continuous practice. In this final paper, we will get acquainted with the procedures of the BLS and the latest guidelines in their implementation. Using the information collected through the survey questionnaire, we will assess the level of knowledge of BLS procedures in nurses and technicians. The survey questionnaire “Knowledge of BLS procedures among nurses / technicians” consisted of 5 questions related to sociodemographic data: age, gender, level of education, working place and work experience. The remainder of the survey questionnaire consisted of 12 questions related to BLS procedures in which respondents were asked to choose the correct answer among the statements offered. The obtained results will confirm whether there is a statistically significant correlation between the level of knowledge of BLS procedures and the level of education, activities in the profession and work experience of the respondents. We will compare our results with the results of similar research in the world. Medical professionals are expected to be well acquainted with BLS procedures and to be well trained to perform them. The goal in the future is to recognize the need for more frequent recurrence of BLS procedures (especially in those services that rarely encounter cardiac arrest) which would ultimately create a basis for improved survival and better outcome of the postresuscitation period among persons who have experienced cardiac arrest.

Objective: Inhalation of noble and other gases after cardiac arrest (CA) might improve neurological and cardiac outcomes. This article discusses up-to-date information on this novel therapeutic intervention. Data sources: CENTRAL, MEDLINE, online published abstracts from conference proceedings, clinical trial registry clinicaltrials.gov, and reference lists of relevant papers were systematically searched from January 1960 till March 2019. Study selection: Preclinical and clinical studies, irrespective of their types or described outcomes, were included. Data extraction: Abstract screening, study selection, and data extraction were performed by two independent authors. Due to the paucity of human trials, risk of bias assessment was not performed DATA SYNTHESIS: After screening 281 interventional studies, we included an overall of 27. Only, xenon, helium, hydrogen, and nitric oxide have been or are being studied on humans. Xenon, nitric oxide, and hydrogen show both neuroprotective and cardiotonic features, while argon and hydrogen sulfide seem neuroprotective, but not cardiotonic. Most gases have elicited neurohistological protection in preclinical studies; however, only hydrogen and hydrogen sulfide appeared to preserve CA1 sector of hippocampus, the most vulnerable area in the brain for hypoxia. Conclusion: Inhalation of certain gases after CPR appears promising in mitigating neurological and cardiac damage and may become the next successful neuroprotective and cardiotonic interventions. (C) 2020 Elsevier Inc. All rights reserved.

This paper presents a review of literature on the impact of the medical emergency team (MET) on inpatient mortality, cardiopulmonary arrests or unscheduled intensive care unit (ICU) admissions. A total of 14,172 abstracts and 98 full text papers were reviewed. In total, 24 met the inclusion criteria, 2 used a cluster-randomized controlled trial, 11 before and after, 6 retrospective analyses, 4 prospective cohorts and 1 not reported. There is moderate to strong evidence that METs are associated with decreased mortality and cardiac arrest rates, and weak evidence on its impact on ICU admission rate reductions. This evidence suffers from the flaws with only two randomized controlled trials examining differing outcome measures with differing results. Poor methodology and failure to report both quality improvement co-interventions and time response rates of METs, limit the strength of the evidence that METs are effective interventions for preventing mortality, code rates or unscheduled ICU admissions. Studies with improved implementation practices and evaluation of the efficacy of MET is warranted.

Every dental practitioner needs a knowledge of the diagnosis and management of medical emergencies. This first paper, in a series of two, deals with the general aspects of emergency treatment, including basic principles applicable to all emergencies and a consideration of the management of cardiac arrest. The second paper deals with more specific aspects of medical emergency management.All dental practitioners require a knowledge of medical emergency management.

This thesis investigated whether out­come after in-hospital cardiac arrest patients could be improved by a cardiopulmonary resuscitation (CPR) educational intervention focusing on all hospital healthcare professionals. Annually in Sweden, approximately 3000 in-hospital patients suffer a cardiac arrest in which CPR is attempted, and which 900 will survive. The thesis is based on five papers: Paper I was a methodological study concluding in a reliable multiple choice questionnaire (MCQ) aimed at measuring CPR knowledge. Paper II was an intervention study. The intervention consisted of educating 3144 healthcare professionals in CPR. The MCQ from Paper I was answered by the healthcare professionals both before (82% response rate) and after (98% response rate) education. Theoretical knowledge improved in all the different groups of healthcare professionals after the intervention. Paper III was an observational laboratory study investigating the practical CPR skills of 74 healthcare professionals’. Willingness to use an automated external defibrillator (AED) improved generally after educa­tion, and there were no major differences in CPR skills between the different healthcare professions. Paper IV investigated, by use of a questionnaire, the attitudes to CPR of 2152 healthcare professionals (82% response rate). A majority of healthcare professionals reported a positive attitude to resuscitation. Paper V was a register study of patients suffering from cardiac arrest. The intervention tended not to reduce the delay to start of treatment or to increase overall survival. However, our results suggested indirect signs of an improved cerebral function among survivors. In conclusion, CPR education and the introduction of AEDs in-hospital – improved healthcare professionals knowledge, skills, and attitudes – did not improve patients’ survival to hospital discharge, but the functional status among survivors improved.