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Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a marked increase in the incidence of in-hospital cardiac arrest (IHCA), with mortality rates surpassing 90% despite cardiopulmonary resuscitation (CPR) efforts. Patients with COVID-19 who experience IHCA are less likely to present with shockable rhythms, have lower rates of return of spontaneous circulation (ROSC), and exhibit significantly lower survival rates. The aim of this paper was to investigate the epidemiology and clinical features of COVID-19 patients who required CPR following an episode of IHCA. Study design and methods: Retrospective analysis of adult patients aged 18 years or older, who were admitted to our critical care unit and diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using reverse transcription polymerase chain reaction (rtPCR) between March 2020 and February 2022. Patients who experienced IHCA at any point during their hospital stay were included in the study. Data were collected for demographics, pre-admission conditions, comorbidities, resuscitation records, severity scores (such as Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II, and Ichikado CT), laboratory results, length of stay, and survival to hospital discharge. Results: Nine hundred and ninety-four patients with a COVID-19 diagnosis were admitted to our high-acuity COVID-19 unit during the study period. Out of those, 129 patients underwent CPR. The median age was 63 years old (52-72). Ninetyone (70.5%) patients were male. Sixty-five (50.8%) patients were Hispanic, 34 (26.6%) Caucasian, 22 (17.2%) African American, and 7 (5.5%) other races. The most common comorbidities were systemic arterial hypertension (48.4%) and diabetes mellitus (32%). Thirty-nine patients (30.5%) had no reported comorbidities. The mean APACHE score was 16 (11-23), and the highest APACHE score during hospitalization was 29 (21.5-35). The mean SOFA score was 4 (2-6.5), with the highest SOFA score during hospitalization being 10 (7-13). The mean Ichikado CT score was 200 (150-245) and an Ichikado CT score >174 was present in 68 (63.6%) patients. Twenty-one (16.3%) patients developed pulmonary embolism, 7 (5.4%) patients developed myocarditis, 22 (17.1%) developed acute kidney injury, and 40 (31%) patients developed disseminated intravascular coagulation (DIC). The most frequent cardiac arrest rhythm was asystole (9.8%), followed by pulseless electrical activity (PEA) (2.6%), pulseless ventricular tachycardia (0.5%), and ventricular fibrillation (0.6%). The mean CPR duration was 22.8 minutes. The mortality of patients that underwent CPR was 98.4%. Conclusions: Most COVID-19 patients who received CPR in this cohort had a severe disease course, with a low survival rate and a short mean survival time. Our findings revealed that male gender, age above 65 years, hospital admission more than 7.5 days after symptom onset, high scores on admission for severity assessment such as APACHE II and SOFA, as well as high levels of creatine phosphokinase (CPK), blood urea nitrogen: creatinine (BUN:Cr) ratio, interleukin 6 (IL- 6), and glucose upon admission, and the presence of a cytokine storm at the time of admission were all factors associated with an increased risk of mortality following CPR. [ABSTRACT FROM AUTHOR]

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims. To acquire epidemiological data on pre-hospital cardiac arrest incidents occurring in the Pilsen Region of the Czech Republic in 2018, and the results of subsequent cardiopulmonary resuscitation Methods. A prospective observational study of the survival rate of out-of-hospital cardiac arrest (OHCA) in patients undergoing CPR carried out by emergency medical service personnel. The observed time period was from January 1st, 2018 until December 31st, 2018. The data were acquired from patients' records in paper and electronic forms. Results. In the monitored period 707 patients with signs of cardiac arrest were recorded in the Pilsen Region with an incidence rate of 128.9 per 100,000 inhabitants. Emergency medical units performed CPR in 484 cases. The incidence rate of pre-hospital CPR was 88.2 cases per 100,000 inhabitants. Spontaneous blood circulation was temporarily or permanently restored in 276 patients (57.0%), 203 (41.9%) patients were transferred to a hospital, and there were 61 (12.6%) cases of survival with Cerebral Performance Category (CPC) score of 1 or 2. The first monitored rhythm was a shockable in 134 (27.7%) cases. In this sub-group ROSC was achieved in 94 (70.1%) cases and 58 (43.3%) of those were subsequently transferred to a hospital. A good CPC result was achieved in 41 (30.6%) patients of this sub group. Conclusion. The study has provided valuable epidemiological data on OHCA and prehospital CPR in the area of the Pilsen Region in 2018. The collected data, compared to international results, show a higher survival rate with good neurological score in 12.6% of cases. [ABSTRACT FROM AUTHOR]

Ventilation during chest compressions can lead to an increase in peak inspiratory pressure. High inspiratory pressure can raise the risk of injury to the respiratory system and make it challenging to deliver the required tidal volume. The utilization of mechanical devices for chest compression has exacerbated this challenge. The aim of this narrative review was to summarize the different mechanical ventilation strategies applied during mechanical cardiopulmonary resuscitation (CPR). To this end, we searched the PubMed and BioMed Central databases from inception to January 2020, using the search terms "mechanical ventilation," "cardiac arrest," "cardiopulmonary resuscitation," "mechanical cardiopulmonary resuscitation," and their related terms. We included all studies (human clinical or animal-based research studies, as well as studies using simulation models) to explore the various ventilation settings during mechanical CPR. We identified 842 relevant articles on PubMed and 397 on BioMed Central; a total of 38 papers were judged to be specifically related to the subject of this review. Of this sample, 17 studies were conducted on animal models, 6 considered a simulated scenario, 13 were clinical studies (5 of which were retrospective), and 2 studies constituted literature review articles. The main finding arising from the assessment of these publications is that a high FIO2 must be guaranteed during CPR. Low-grade evidence suggests turning off inspiratory triggering and applying PEEP ≥ 5 cm H2O. The analysis also revealed that many uncertainties persist regarding the ideal choice of ventilation mode, tidal volume, the ventilation rate setting, and the inspiratory:expiratory ratio. None of the current international guidelines indicate the "best" mechanical ventilation strategy to apply during mechanical CPR. We propose an operating algorithm worthy of future discussion and study. Future studies specifically addressing the topics covered in this review are required. [ABSTRACT FROM AUTHOR]

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Background: Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).Objectives: We performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care.Methods: MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated.Results: The search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01-7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11-10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low).Conclusion: The effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiopulmonary resuscitation (CPR) is alongside electrical defibrillation the most crucial countermeasure for sudden cardiac arrest, which affects thousands of individuals every year. In this paper, we present a novel approach including sinusoid models that use skeletal motion data from an RGB-D (Kinect) sensor and the Differential Evolution (DE) optimization algorithm to dynamically fit sinusoidal curves to derive frequency and depth parameters for cardiopulmonary resuscitation training. It is intended to be part of a robust and easy-to-use feedback system for CPR training, allowing its use for unsupervised training. The accuracy of this DE-based approach is evaluated in comparison with data of 28 participants recorded by a state-of-the-art training mannequin. We optimized the DE algorithm hyperparameters and showed that with these optimized parameters the frequency of the CPR is recognized with a median error of ± 2. 9 compressions per minute compared to the reference training mannequin. • An approach to derive the compression frequency and depth of CPR training is proposed. • RGB-D data of the Kinect Motion Capture sensor is used. • The motion data is continuously fitted to sine models using an evolutionary algorithm. • The frequency of CPR is measured with an error of 2.9 cpm compared to the reference. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth. J Med Internet Res 2022;24(5):e36086 doi:10.2196/36086 [ABSTRACT FROM AUTHOR]

In the past few decades, assessment of exhaled CO2 in both intubated and non-intubated patients has evolved into an essential component in many aspects of patient monitoring. Besides the basic assessment of ventilation, exhaled CO2 monitoring can provide valuable patient safety information and critical physiologic data in regard to the ventilation and perfusion matching in the lungs, cardiac output, and metabolic rate. Despite these important clinical monitoring benefits and widespread availability, exhaled CO2 monitoring is often underutilized. The purpose of this paper is to review the importance and present the extensive body of knowledge to support the use of exhaled CO2 monitoring in various areas of clinical practice. Advanced application concepts and the future development of exhaled CO2 monitoring will also be discussed. [ABSTRACT FROM AUTHOR]

The purpose of our paper is to challenge the current acceptance of cardiopulmonary resuscitation (CPR) in hospice care. We contend CPR should not be part of the hospice experience because it is contrary to the goals and mission of hospice. While understanding the Medicare conditions of participation do not allow refusal of hospice enrollment based on the presence (or absence) of advance directives, we propose a transparent, common sense approach for hospices to consider when faced with a hospice eligible patient who desires CPR despite medical advice to the contrary. [ABSTRACT FROM AUTHOR]

Background: Health/fitness facilities are popular venues for physical activity, where increasingly more individuals at risk of cardiovascular events exercise to achieve positive health outcomes. The aim of our study was to analyze cardiac emergency preparedness in health/fitness facilities in Queensland, Australia. Design: Cross-sectional survey of health/fitness facilities in Queensland. Methods: A risk management questionnaire was administered over 7 months, July 2009 to January 2010, using an online or paper-based version. The data are presented as the proportion of survey respondents giving specific responses to questionnaire items related to cardiac emergency preparedness, especially the provision of automated external defibrillators (AEDs). Results: Fifty-two health/fitness facility managers responded to the survey. Most of the surveyed facilities conducted pre-activity screening (92%). Of those with a written emergency plan (79%), only 37% physically rehearsed their emergency response systems at regular intervals. Ninety-five percent of the facilities had fitness employees with a current first aid/cardiopulmonary resuscitation certificate and training. Of the 10 (19%) facilities with an on-site AED, only 6 had staff qualified to use the AED in an emergency, and only 6 had the AED as part of a public access defibrillator program. Conclusion: This is the first study to report that cardiac emergency preparedness is not optimal in the health/fitness facilities in Australia. Development of policies and procedures for training health/fitness professionals in emergency procedures is needed to minimize the risk when exercise-induced cardiac events occur at health/fitness facilities. [ABSTRACT FROM AUTHOR]

Mountain rescue operations often present helicopter emergency medical service crews with unique challenges. One of the most challenging problems is the prehospital care of cardiac arrest patients during evacuation and transport. In this paper we outline a case in which we successfully performed a cardiopulmonary resuscitation of an avalanche victim. A mechanical chest-compression device proved to be a good way of minimizing hands-off time and providing high-quality chest compressions while the patient was evacuated from the site of the accident. [Copyright &y& Elsevier]

Summary: Knowledge and skills relating to cardiopulmonary resuscitation tend to be lost over time. The combination of simulation sessions with online video records and online feedback allows for an enduring record of skills sessions to assist students in retaining and revising their learning. This paper reports a qualitative evaluation of such a combination used in inter-disciplinary sessions for volunteer nursing and medical students. Methods included focus groups and free text questionnaires; data were gathered from fourteen students and three teachers. Students had used the online material in a variety of personal ways, and found that the addition to their learning was significant. Their memories of the simulation sessions and of the feedback received immediately afterwards were incomplete, and repeated viewing enabled them to identify good and poor practice with more confidence, and to reflect more carefully on their own and others'' practice. Teachers found it easier to give more detailed feedback when given the chance to watch the video than immediately after the session. All felt that the sessions would ideally be embedded in the curriculum. [Copyright &y& Elsevier]

Copyright of Investigacion en Enfermeria: Imagen y Desarrollo is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Cardiac arrest is singly one of the most important conditions to recognize and treat well. In order to ensure the optimal treatment and uniform implementation worldwide, guidelines are published every fifth year. A considerable amount of research is done, and although there have been advances, there is always room for improvement. Prospective studies of cardiac arrest in humans are extremely difficult to conduct, especially randomised studies, and the number of patients involved in the studies is sparse. This paper provides updated available information on cardiac arrest, as well as a discussion of recommendations, based on the guidelines published in November 2005 by the International Liaison Committee on Resuscitation. [Copyright &y& Elsevier]

Abstract: Many nurses will be familiar with the demanding role of caring for a patient who requires cardiopulmonary resuscitation following a sudden, life-threatening illness or event. This paper examines the phenomenon of sudden cardiac death and in particular, focuses on the medical–technical discourse of dying and death in the context of resuscitation for the victims of sudden cardiac arrest. The process of dying is distinguished from the end point of death by drawing upon biomedical determinants and definitions of death. Comparison is made between the use of resuscitation techniques in an attempt to reverse ‘clinical death’ and the notion of a ‘natural death’ that is proffered as a means to a ‘good’ or ‘ideal’ death. The humanistic versus technological imperative is further deliberated by examining the role of the emergency team in end of life care and includes consideration of the effects that medical dominance may have on the dying process. The practice of family witnessed resuscitation is recognised as one way in which a holistic approach to emergency resuscitative care may be achieved. [Copyright &y& Elsevier]

The proportion of patients starting renal replacement therapy who are elderly, dependent and have multiple co-morbidities is the fastest growing chronic kidney disease (CKD) population in Canada. Most professional nephrology organizations recommend that hemodialysis patients should be encouraged to write advance directives (AD). Advance directives or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment and personal care. ACP discussions occur infrequently between the hemodialysis patient and the health care team. Failure to initiate ACP discussions is often due to barriers such as comfort level, time constraints and lack of privacy. This paper reports the results of a small (n = 30) continuous quality improvement (CQI) initiative examining the effectiveness of developing and using a pamphlet to introduce the topic of AD with hemodialysis patients and their families. In this study, it was found that many hemodialysis patients have thought about cardiopulmonary resuscitation (46.6%), mechanical ventilation (63.3%) and withdrawal of dialysis (56.6%). The majority of hemodialysis patients (70%) found that a pamphlet is helpful to introduce the topic of AD. As a consequence of this CQI initiative, our renal program has further revised the pamphlet and is beginning to incorporate its use in patient care within the hemodialysis unit. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is an emergency procedure that can increase survival after a cardiac arrest. Performing CPR effectively requires both procedural knowledge and manual skills. Traditional CPR training methodology includes lessons led by instructors and supervised practice on mannequins, thus requiring considerable resources.Objective: This paper proposes a new methodology for low-cost CPR training based on virtual reality (VR) with and without the addition of a physical mannequin. Moreover, it describes an experimental evaluation of the methodology that assessed gain in manual skills during training, transfer of procedural knowledge and manual skills in a final assessment, and changes in self-efficacy with three measurements over time (pre-training, post-training, and post-assessment).Methods: We implemented a VR application that supports the proposed methodology, and can thus be used with or without a mannequin. The experimental evaluation involved 30 participants who tried CPR in VR twice, performing two repetitions of 30 chest compressions per trial. Half participants tried the VR application with the mannequin and half without it. Final assessment required all participants to perform CPR on the mannequin without the assistance of VR. To assess self-efficacy, participants filled in a questionnaire at the three times of measurement.Results: Mixed-design ANOVAs showed effects of repetition, effects of group, or interaction between the two variables on manual skills assessed during training. In the final assessment, participants in both groups correctly remembered most of the steps of the procedure. ANOVAs revealed differences between the two groups only in pressure-related skills (better with mannequin) and in the number of wrong steps added to the procedure (better without mannequin). Mixed-design ANOVA showed a self-efficacy increase in both groups after training, which was maintained after final assessment.Conclusions: The proposed VR methodology for CPR training has a positive effect on procedural knowledge, manual skills, and self-efficacy, with as well as without the physical mannequin. Trials on a mannequin are required to understand the correct pressure for chest compression. This supports the adoption of the proposed VR methodology to reduce instructor and mannequin time required to teach CPR to trainees. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we present the framework of a LIfe Support Simulation Application (LISSA) designed to teach and learn cardiopulmonary resuscitation (CPR) skills. DLISSA exploits video game technology to link in a single framework computer-based simulations of CPR emergencies with the functionalities of e-learning platforms. DEmergency situations are presented as problems that the learner has to solve in a game mode. Learner actions are registered in a database. DThis information is used to present new problems to the learner in an adaptive learning mode.DLISSA can be used as a substitute or a complement for traditional CPR classroom-based instruction Dor to refresh and improve CPR skill retention over time. [Copyright &y& Elsevier]

Background: E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches.Objective: This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment.Methods: A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements.Results: Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group.Conclusions: Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures. [ABSTRACT FROM AUTHOR]