Search

Background: Extracorporeal cardiopulmonary resuscitation has become a recommended treatment option for patients with severe hypothermia with cardiac arrest. Minimal invasive extracorporeal circulation (MiECC) may offer advantages over the current standard extracorporeal membrane oxygenation (ECMO)., Methods: Retrospective cohort analysis of hospital database for patients with accidental hypothermia and extracorporeal rewarming with MiECC admitted between 2010 and 2019., Results: Overall, six of 17 patients survived to hospital discharge. Eleven patients suffered accidental hypothermia in an alpine and six in an urban setting. Sixteen patients arrived at the hospital under ongoing cardiopulmonary resuscitation (CPR). CPR time was 90 minutes (0-150). Four patients survived from an alpine setting and two from an urban setting with CPR duration of 90 minutes (0-150) and 85 minutes (25-100), respectively. Asphyctic patients tended to have lower survival (one of seven patients). Two patients of six with major trauma survived., Conclusion: MiECC for extracorporeal rewarming from severe accidental hypothermia is a feasible alternative to ECMO, with comparable survival rates., (© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: In adults with refractory out-of-hospital cardiac arrest, when conventional cardiopulmonary resuscitation (CPR) alone does not achieve return of spontaneous circulation, extracorporeal CPR is attempted to restore perfusion and improve outcomes. Considering the contrasting findings of recent studies, we conducted a meta-analysis of randomized controlled trials to ascertain the effect of extracorporeal CPR on survival and neurological outcome., Methods: Pubmed via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to February 3, 2023, for randomized controlled trials comparing extracorporeal CPR versus conventional CPR in adults with refractory out-of-hospital cardiac arrest. Survival with a favorable neurological outcome at the longest follow-up available was the primary outcome., Results: Among four randomized controlled trials included, extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome at the longest follow-up available for all rhythms (59/220 [27%] vs. 39/213 [18%]; OR = 1.72; 95% CI, 1.09-2.70; p = 0.02; I 2  = 26%; number needed to treat of 9), for initial shockable rhythms only (55/164 [34%] vs. 38/165 [23%]; OR = 1.90; 95% CI, 1.16-3.13; p = 0.01; I 2  = 23%; number needed to treat of 7), and at hospital discharge or 30 days (55/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.01; I 2  = 0.0%). Overall survival at the longest follow-up available was similar (61/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.59; I 2  = 58%)., Conclusions: Extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome in adults with refractory out-of-hospital cardiac arrest, especially when the initial rhythm was shockable., Review Registration: PROSPERO CRD42023396482., (© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Objectives: To test the feasibility of a novel method of heart donation under circulatory death criteria that allows precardiectomy donor heart assessment., Materials and Methods: This is a translational study utilizing 16 female Yorkshire pigs in a series of eight heart transplant procedures under a circulatory death model., Results: Successful resuscitation of the donor hearts occurred in seven out of eight animals. All seven of these hearts were deemed to have good function and were successfully transplanted. In the animal in which donor heart resuscitation was not successful, the transplant was aborted, and a left ventricular assist device (LVAD) was placed in the recipient's heart., Conclusion: This animal study demonstrates the feasibility of using this novel technique for resuscitation and precardiectomy evaluation of donated after circulatory death hearts. For those donor hearts without adequate function, an LVAD can be safely implanted as a "bail-out" option. The limitations of this technique are the patient population to which it can be applied (only those patients eligible and consented for LVAD)., (© 2019 Wiley Periodicals, Inc.)

Background The incidence of cardiac arrest and cardiopulmonary resuscitation continues to increase worldwide largely due to greater awareness of the symptoms of cardiac events and increased attention to cardiopulmonary resuscitation training in the community. Globally, predicted survival rates after cardiopulmonary resuscitation have remained at 10% for decades and although patient outcome remains unpredictable, there is a positive trend in life expectancy. For a resuscitation attempt to be classed as successful, not only survival but also quality of life has to be evaluated. Aim The aim of this review was to examine literature that explores the quality of life ( QOL) for survivors' after CPR and the influence cognitive impairment, anxiety, depression and post-traumatic stress disorder ( PTSD) has had on their QOL. Review methods This review follows Whittemore and Knafl's framework for an integrative literature review. Electronic databases EBSCO, Ovid, PubMed and EMBASE were searched. After application of the inclusion and exclusion criteria, thirty-six papers published from January 2000 to June 2015 were included in this review. Results These papers represent a broad spectrum of research evaluating quality of life for survivors of cardiopulmonary resuscitation. The heterogeneous research methods and vast number of different research tools make it challenging to compare the findings. The majority of papers concluded that quality of life for survivors of cardiac arrest and cardiopulmonary resuscitation was generally acceptable. However, studies also described survivors' experience of anxiety, depression, post-traumatic stress and cognitive dysfunction. Conclusion A majority of papers reported an acceptable quality of life if the patient survived to hospital discharge. The heterogeneity in quantitative papers was noticeable and indicates a marked variance in patient outcomes. This review highlights the absence of specialized tools used to investigate survivors' experience of the event. Further exploration of the impact cardiopulmonary resuscitation has on the individual may improve ongoing rehabilitation and quality of life levels for survivors. [ABSTRACT FROM AUTHOR]

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

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

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

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

Background: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out‐of‐hospital cardiac arrest, CPR is now frequently used for in‐hospital cardiac arrest (IHCA) with different causes and outcomes. Aims: This paper aims to describe clinical understanding of the role of in‐hospital CPR and perceived outcomes for IHCA. Methods: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do‐not‐attempt‐CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Results: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety‐one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. Conclusions: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision‐making around patient deterioration. This may involve reframing current in‐hospital algorithms and uncoupling CPR from wider resuscitative measures. [ABSTRACT FROM AUTHOR]

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

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

The article presents information on the research paper published in February issue of the journal which discusses the use of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cardiac arrest and the survival rate of patients. Topics include treating out-of-hospital cardiac arrest (OHCA) patients with ECPR, improving and optimizing the quality of CPR by using mechanical CPR guided with endtidal CO2 (ETCO2), and focusing on quality of CPR than the time-based inclusion criteria.

The article discusses various reports published within the issue, including one by Stenhouse and Endacott on caring for pregnant women in critical care units, one by Engstrom and Lindberg on the experiences eight mothers had in intensive care units following complicated births and one by Pattison and Eastham on outreach episodes in a specialist oncology hospital.

Abstract: Cardiopulmonary resuscitation (CPR) is a first aid survival technique used to recover victims of cardiac arrest. To learn CPR different handheld device applications have been proposed. Most of them are based on sophisticated graphics and interaction techniques that make them inaccessible to visually impaired people. In this paper, we propose CPRforBlind, a video game designed to introduce the main steps of the CPR protocol to visually impaired people. The game is composed of different mini‐games inspired by the CPR steps proposed by European Resuscitation Council. The player acts as a helper who has to save the victim by using tactile interaction to solve the challenges assigned to each mini‐game. To test the game, 16 participants from which 8 are blind have been considered. After and before playing the game participants answered different questionnaires related to CPR knowledge, playability and enjoyability. The obtained results are very promising detecting a great improvement on CPR knowledge. In addition, blind players enjoyed the game and found it easy to play. [ABSTRACT FROM AUTHOR]

Relatives’ presence in connection with cardiopulmonary resuscitation and sudden death at the intensive care unit Within Norwegian intensive care units it is common to focus on the needs of the next of kin of patients undergoing end-of-life care. Offering emotional and practical support to relatives is regarded as assisting them in the initial stages of their grief process. It has also become usual to encourage relatives to be present at the time of death of close relatives. How can dignified end-of-life care coexist with the sometimes turbulent and dramatic character of intensive care in the highly technological environment of intensive care units? This paper describes a case study based on an incident that took place at the intensive care unit (ICU) of Trondheim University Hospital, Norway, in which the relatives of a newly deceased patient voiced unusually strong dissatisfaction with the way they were excluded in connection with cardiopulmonary resuscitation (CPR). The next of kin's criticism highlights an important paradox as well as a degree of inconsistency in lifesaving and end-of-life care at the ICU. I argue that an investigation of the multiple identities within medical practice can illuminate the potential for clashes between lifesaving and end-of-life care, as described and analysed in this paper. [ABSTRACT FROM AUTHOR]

Two papers in this issue address the limits of surrogates' authority when making life-and-death decisions for dying family members or friends. Using palliative sedation as an example, Jeffrey Berger offers a conceptual argument for bounding surrogate authority. Since freedom from pain is an essential interest, when imminently dying, cognitively incapacitated patients are in duress and their symptoms are not manageable in any other way, clinicians should be free to offer palliative sedation without surrogate consent, although assent should be sought and every effort made to work with surrogates as harmoniously as possible. Ellen Robinson and her colleagues report on the implementation of a policy at Massachusetts General Hospital that supports do-not-resuscitate orders when cardiopulmonary resuscitation is likely to be ineffective or harmful, even if surrogates disagree. The 'Doing No Harm' policy at MGH allows for what MGH calls a 'medically indicated DNR' and what in some other places is called 'a unilateral DNR'-the writing of an order not to provide cardiopulmonary resuscitation, regardless of surrogate disapproval. These kinds of DNR policies have emerged in some hospitals across the country and for much the same reason that Berger provides in his argument regarding palliative sedation. I support the reasoning and the policies in both the Berger and Robinson papers. However, as the authors would most likely agree, the problems they aim to remedy are not simply about the scope of surrogate and professional authority. They are also symptoms of inattention to professional obligations and system failures. [ABSTRACT FROM AUTHOR]

Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation-what is real and what is simulated-is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, and créolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman. [ABSTRACT FROM AUTHOR]

The relationship between theory and practice has received considerable attention within the nursing literature. This paper uses qualitative data from debriefing interviews with nurses following episodes of cardiopulmonary resuscitation (CPR) to illustrate the complexities of translating sanitized theory into the messiness of practice. The interplay of affect and cognition on both learning from experience and on professional practice are explored. The feelings engendered by the CPR event and the labour required for their management form the second and major part of the paper. These are explored by examining the realities of a CPR event with its accompanying threat of death: success and failure, dignity versus indignity and the place of appropriate emotions throughout. [ABSTRACT FROM AUTHOR]

This review paper summarises the key changes made to the resuscitation guidelines used in Australia and New Zealand. They were released by the Australian and New Zealand Committee on Resuscitation in January 2016. These are local adaptations of the evidence previously published in October 2015 by the International Liaison Committee on Resuscitation (ILCOR). They are presented across the main working groups in ILCOR: ALS, BLS, paediatrics, neonates, acute coronary syndromes, first aid and 'Education, Implementation and Teams'. [ABSTRACT FROM AUTHOR]

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions. [ABSTRACT FROM AUTHOR]

Introduction Emergencies in radiology are infrequent but potentially lethal. Australian and New Zealand radiologists are advised to undergo resuscitation training at least every three years; however, little is known about their experience and confidence in managing common emergencies relevant to their clinical practice. This paper describes the current experience and confidence of radiologists and radiology trainees in Australia and New Zealand in the management of common medical emergencies. Methods A cross-sectional online survey of trainees and fellows of the Royal Australian and New Zealand College of Radiology collected data on training and learning preferences relating to resuscitation and life-support skills, access to emergency medical care, and knowledge, confidence and ability in managing a variety of medical emergencies. Results There were 602 responses to the survey (response rate 23.4%). The majority of respondents were interested in learning more about the management of contrast reactions, cardiac arrest, ischaemic chest pain and basic life support. Self-rated knowledge, confidence and ability were higher in respondents who had completed life-support training within the previous three years. In this group, however, more than 40% rated their ability at managing contrast reactions as poor or fair, while more than 60% rated their ability as poor or fair for management of cardiac arrest, basic life support, advanced life support and dosing of adrenaline. Preferred resuscitation training modalities included simulation, small-group tutorials and workshops. Conclusion Self-reported level of skill and expertise in the management of potential emergencies in radiology is suboptimal among a large number of respondents. Consideration should be given to addressing this by improving access to specific training. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to determine the experiences and attitudes of Turkish critical care nurses concerning family presence during cardiopulmonary resuscitation. Background. The debate surrounding family-member presence in resuscitation areas has been evolving since the 1980s. The practice of performing resuscitation of adults in the presence of family members is controversial and has stimulated discussion and debate worldwide. Design. A descriptive survey. Method. The survey was carried out in 2007 with 135 critical care nurses from two university hospitals in İzmir. A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a three-point Likert scale. The attitudes of the nurses were explored in three areas: decision making, processes and outcomes of resuscitation. Results. Of the nurses, only 22·2% experienced a situation where family members were present during cardiopulmonary resuscitation. Most of these nurses ( n = 20) had one or more negative experiences. The majority disagreed that family members should always be offered the opportunity to be with the patient during cardiopulmonary resuscitation. The most common concerns for not favouring family-witnessed resuscitation were reported as performance anxiety, fear of causing psychological trauma to family members and increased risk of litigation. Conclusions. Many Turkish critical care nurses have no knowledge of family-witnessed resuscitation and do not support the practice. We suggest that Turkish critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation and the culturally appropriate policies concerning this subject should be changed in Turkish hospitals. Relevance to clinical practice. Most critical care nurses in Turkey are not supportive of family-witnessed resuscitation. All critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation. [ABSTRACT FROM AUTHOR]

Title. Presence of patients’ families during cardiopulmonary resuscitation: physicians’ and nurses’ opinions. Aim. This paper is a report of a study to determine the opinions of physicians and nurses who work in a university hospital intensive care unit and emergency department about the presence of patients’ families during cardiopulmonary resuscitation in these units. Background. Healthcare professionals have conflicting opinions about the presence of patients’ families during cardiopulmonary resuscitation. Families who are allowed to be present have less fear and worry, feel they have supported their family member and are able to cope more easily. Method. The data for this descriptive questionnaire study were collected between November 2006 and January 2007. The respondents were 62 physicians and 82 nurses who worked in an emergency department or in cardiology or anaesthesia intensive care units in Turkey. The data were collected using a questionnaire and the responses summarized using frequencies and percentages. The chi-squared test was performed to test for differences in the opinion by profession, educational level, or number of years of working experience in the profession. Findings. The response rate was 79%. Of the respondents, 82·6% did not think it was appropriate for patients’ families to be present during cardiopulmonary resuscitation. The most common concerns mentioned were that the family would interfere with the team’s activities (56·3%) and that resuscitation is a very traumatic procedure (43·6%). Conclusion. Policies need to be developed regarding this topic because the absence of policy can cause misunderstanding and differences in practice. Further research is needed to determine what public education is needed to facilitate implementation of such policies. [ABSTRACT FROM AUTHOR]

Title. Nurses’ involvement in ‘do not resuscitate’ decisions on acute elder care wards Aim. This paper reports the involvement of nurses in ‘do not resuscitate’ decision-making on acute elder care wards and their adherence to such decisions in the case of an actual cardiopulmonary arrest. Background. Previous literature showed that nurses are involved in half or less than half of ‘do not resuscitate’ decisions in hospitals, but their involvement in this decision-making on acute elder care wards in particular has not been investigated. Method. A questionnaire was sent in 2002 to the head nurses of all acute elder care wards in Flanders, Belgium ( n = 94). They were asked whether nurses had been involved in the last ‘do not resuscitate’ decision-making process on their ward and whether nurses ‘never’, ‘rarely’, ‘sometimes’, ‘often’ or ‘always’ started resuscitation in case of cardiopulmonary arrest of patients with ‘do not resuscitate’ status and of those without. Results. The response rate was 86·2% ( n = 81). In 74·7% of the last ‘do not resuscitate’ decisions on acute elder care wards in Flanders, a nurse was involved in the decision-making process. For patients with ‘do not resuscitate’ status, 54·3% of respondents reported that cardiopulmonary resuscitation was ‘never’ started on their ward, ‘rarely’ on 39·5% and ‘sometimes’ on 6·2%. For patients without ‘do not resuscitate’ status, nurses started cardiopulmonary resuscitation ‘rarely’ or ‘sometimes’ on 22·2% of all wards, and ‘often’ or ‘always’ on 77·8%. Conclusion. To make appropriate ‘do not resuscitate’ decisions and to avoid rash decision-making in cases of actual cardiopulmonary arrest, nurses should be involved early in ‘do not resuscitate’ decision-making. If institutional ‘do not resuscitate’ guidelines were to stress more clearly the important role of nurses in all kinds of end-of-life decisions, this might improve the ‘do not resuscitate’ decision-making process. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. Background. The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required. Method. A review of available literature regarding ACLS training has been conducted for this discussion. Data sources and selection: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. Results. There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. Conclusions. The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. Relevance to clinical practice. It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes. [ABSTRACT FROM AUTHOR]

Background: Physician Orders for Life‐Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. Methods: California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content—orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. Results: POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two‐thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. Conclusions: Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative. [ABSTRACT FROM AUTHOR]

Introduction: Medical emergency response within the hospital involves an interdisciplinary team, including pharmacists. Pharmacist involvement in these teams has increased over time due to published benefits of their involvement. Development of emergency response skills may start during pharmacy residency, although limited data suggest how this is best implemented. Objectives: Limited data evaluate post‐graduate year 2 (PGY2) pharmacy resident training for emergency response, as well as PGY2 program values for this in screening/ranking candidates, which may help post‐graduate year one (PGY1) pharmacy residents identify residency programs that are a good fit for their career goals. Methods: A list of PGY2 critical care (CC) and emergency medicine (EM) programs were identified. The questionnaire included program demographics, characteristics of PGY2 emergency response training, and PGY2 residency program values of PGY1 emergency response exposure for screening and ranking applicants for their programs. A Fisher's exact test was used to compare differences between CC and EM programs for these outcomes. Results: A total of 85 complete responses were analyzed (response rate by all identified programs: CC = 36.4%; EM = 32.1%). Emergency response training was often with both core and longitudinal experiences (72.9%), although differed by type of program (p < 0.001). Both CC and EM programs considered PGY1 pharmacy resident exposure to emergency response in screening candidates (33.9% and 57.7%, respectively), as well as ranking candidates (22% and 38.5%, respectively). For CC programs, both Advanced Cardiovascular Life Support certification and quantity of PGY1 emergency response ranked as the most important characteristics, while EM programs ranked quantity as the most important. Conclusion: The results of this survey indicate heterogeneity in PGY2 CC and EM emergency response training. PGY1 applicants for these programs should consider their experience with emergency response as a potential factor in identifying an appropriate program for their training. [ABSTRACT FROM AUTHOR]

Objective: To report the prevalence of initial shockable cardiac arrest rhythms (I‐SHKR), incidence of subsequent shockable cardiac arrest rhythms (S‐SHKR), and factors associated with I‐SHKRs and S‐SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR. Design: Multi‐institutional prospective case series from 2016 to 2021, retrospectively analyzed. Setting: Eight university and eight private practice veterinary hospitals. Animals: A total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry. Measurements and Main Results: Logistic regression was used to evaluate association of animal, hospital, and arrest variables with I‐SHKRs and S‐SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I‐SHKRs. Odds for I‐SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S‐SHKRs. Odds for S‐SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I‐SHKRs nor S‐SHKRs were significantly associated with ROSC. Conclusions: I‐SHKRs and S‐SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates. [ABSTRACT FROM AUTHOR]

Background: Patients' treatment decisions may be influenced by the ways in which treatment options are presented. There is little evidence on how patients with advanced cancer choose preferences for advance directives (ADs) in China. Informed by behavioural economics, we assess whether end‐of‐life (EOL) cancer patients held deep‐seated preferences for their health care and whether default options and order effects influenced their decision‐making. Methods: We collected data on 179 advanced cancer patients who were randomly assigned to complete one of the four types of ADs: comfort‐oriented care (CC) AD (comfort default AD); a life extension (LE)‐oriented care option (LE default AD); CC (standard CC AD) and LE‐oriented (standard LE AD). Analysis of variance test was used. Results: In terms of the general goal of care, 32.6% of patients in the comfort default AD group retained the comfort‐oriented choice, twice as many as in the standard CC group without default options. Order effect was significant in only two individual‐specific palliative care choices. Most patients (65.9%) appointed their children to make EOL care decisions, but patients choosing the CC goal were twice as likely to ask their family members to adhere to their choices than patients who chose the LE goal. Conclusion: Patients with advanced cancer did not hold deep‐seated preferences for EOL care. Default options shaped decisions between CC and LE‐oriented care. Order effect only shaped decisions in some specific treatment targets. The structure of ADs matters and influence different treatment outcomes, including the role of palliative care. Patient or Public Contribution: Between August and November 2018, from 640 cancer hospital medical records fitting the selection criteria at a 3A level hospital in Shandong Province, we randomly selected 188 terminal EOL advanced cancer patients using a random generator programme to ensure all eligible patients had an equal chance of selection. Each respondent completes one of the four AD surveys. While respondents might require support in making their healthcare choices, they were informed about the purpose of our research study, and that their survey choices would not affect their actual treatment plan. Patients who did not agree to participate were not surveyed. [ABSTRACT FROM AUTHOR]

Panel (a) shows an example from that reference where end-tidal carbon dioxide (ETCO2) is initially < 1 kPa for a sustained (>7 breath) period, but rises with improved cardiopulmonary resuscitation (CPR) quality and treatment (the patient may still die despite this). Keywords: blood gases; cardiac arrest; difficult intubation; hypoxia; lung ventilation EN blood gases cardiac arrest difficult intubation hypoxia lung ventilation 937 942 6 07/06/23 20230801 NES 230801 The principle that using waveform capnography is essential to confirm correct tracheal tube placement dates from the 1980s [[1]], and its mandatory use has been repeated in successive minimum monitoring guidelines [[2]]. Some cases of unrecognised oesophageal intubation highlighted the need to extend this principle to cardiopulmonary resuscitation (CPR), where it had been wrongly assumed that cardiac arrest would invariably result in a flat waveform making capnography useless, but this is not the case. [Extracted from the article]

The effect of the dimensions of the thoracic cage on the resuscitation outcome of cardiopulmonary resuscitation (CPR) maneuvers has long been debated. In this study, the effect of changes in the rib cage dimensions on the achieved compression depth was investigated using finite element simulations. A total of 216 different rib cage geometry models were considered and, in each case, the result of applying different levels of compression force up to 600 N were simulated. The Haller Index of the rib cage is defined as the ratio of the transverse diameter and the antero‐posterior diameter. Our results suggest that, with a fixed level of compression force, performing CPR on rib cages having a low Haller Index and/or a larger height leads to compression depths below the average. Alternatively, if a target compression depth is set for CPR, in general a lower compression force would be required for individuals with higher Haller Index and/or lower chest height. In addition, present results indicate that wider chested individuals will experience lower stress levels on their ribs to achieve the required CPR target depth. Moreover, in the present study we propose predictive models, based on anthropometric parameters, for compression depth and rib stress during chest compressions. In particular, the model suggests that in future correlations of empirical CPR data the patients' Haller index and vertical (sagittal) cross‐area are the best parameters to be used as independent variables in a fit. [ABSTRACT FROM AUTHOR]

This paper reports on a research study carried out in an independent hospital in the south east of England. The aim of the study was to assess the basic life support skills of nurses in order to compare the results with those reported for nurses in public hospitals. The findings show that the basic life support skills of the nurses studied are poor but no worse than those of their public sector colleagues. [ABSTRACT FROM AUTHOR]

• Nursing has been described as a moral endeavour (Seedhouse, 1988; Berger et al., 1991), the art of dealing with ethical issues of right and wrong. • Within the nursing literature, ethical issues are a major topic for discussion. Berger et al. (1991) explain that this reflects larger societal concerns about ethics in business, industry and government. • The development of advanced technology and life-sustaining treatments such as cardiopulmonary resuscitation (CPR) has heightened the dilemmas of moral decision making. CPR was developed in the 1960s as an emergency life-saving procedure, although it is currently used on anyone who does not have a not-forresuscitation status (Anon., 1980). • In this paper, an ethical issue involving the decision of whether or not to resuscitate a stroke patient is discussed. An overview of the main ethical theories is presented because they provide a framework for an explication of ethical decisionmaking. The options available to those involved are then discussed in relation to relevant research. Finally, a conclusion is drawn from the ensuing situation. [ABSTRACT FROM AUTHOR]

In many long-term care settings, cardiopulmonary resuscitation (CPR) is regarded as an available treatment option. However, for the majority of long-term care residents the expected outcome following CPR is poor. This descriptive study explored the CPR decision-making process in two long-term care institutions. This was accomplished through the administration of questionnaires to nursing staff, residents, residents' family members and through completion of a chart review of deceased individuals. This paper primarily addresses the role of nurses in the CPR decision-making process in long-term care. Nurses were rarely explicitly involved in the CPR decision-making process. Knowledge deficits of nurses concerning the CPR policy at the institutions and the expected outcomes of CPR were identified. Also noted were inconsistencies between policy and practice, with CPR being withheld in practice more often than dictated by protocol. Strategies to facilitate the CPR decision-making process in long-term care settings are suggested, and specific roles for nurses in relation to CPR decision making are presented. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is an essential skill required by critical care nurses. Evidence has shown that the use of a novel method called simulation‐based flipped classroom (SBFC) can save training time in nursing laboratories and, to some extent, enhance social distancing during the current COVID‐19 pandemic. Aim: To evaluate the effects of SBFC on nursing students' acquisition of CPR skills. Study Design: A two‐parallel prospective, single‐centre, simulation‐based, randomized, controlled trial. Methods: The total sample size was 326 students. A CPR video was recorded and uploaded on Microsoft Teams channel for the SBFC group only. Thereafter, both groups demonstrated and redemonstrated the CPR procedure. Both groups were then compared according to the simulation experience satisfaction scale and CPR skills acquisition checklist. Results: Two equally randomly selected groups of 163 undergraduate nursing students completed the study. The SBFC group had a significantly better satisfaction with the simulation experience than the traditional simulation (TS) group (p = 0.03). As regards the mean score of the CPR checklist after simulation, the SBFC group had a significantly higher score than TS group (p = 0.01). Conclusions: SBFC using a pre‐recorded video can be an effective method that can reduce the time needed for CPR clinical simulation and can be used for the CPR simulation among critical care nurses. Relevance to Clinical Practice: This study provides critical care nursing educators with a deep understanding regarding the benefits and value of utilizing the SBFC method in the clinical training of CPR skills. SBFC can be used to increase critical care nurses' satisfaction and skill acquisition during CPR training. [ABSTRACT FROM AUTHOR]

Background: Inhospital cardiac arrest (IHCA) is an uncommon but challenging problem. Aims: To investigate the management and outcomes of IHCA, and to investigate the effect of introducing a medical emergency team (MET) on IHCA prevalence. Methods: Retrospective medical record review of 176 adult IHCA episodes at Box Hill Hospital, a university‐affiliated public hospital in metropolitan Melbourne, from July 2012 to June 2017. Inpatients receiving cardiopulmonary resuscitation for IHCA, in inpatient wards, intensive care unit, cardiac catheterisation laboratory and operating theatres were included. Data collected included demographics, resuscitation management and outcomes. Average treatment effect (ATE) was derived from margins estimates and linear regression fitted to hospital outcome, adjusted for IHCA factors. An exponentially weighed moving average control chart was used to explore IHCA prevalence over time. Results: There were 65.3% of IHCA patients who died in hospital. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with higher likelihood of survival to discharge were initial cardiac of rhythm ventricular tachycardia (VT) (ATE 0.10 (95% CI = −0.03 to 0.25)) or ventricular fibrillation (VF) (ATE 0.28 (95% CI = 0.11–0.46)), cardiac monitoring at the time of arrest (ATE 0.06 (95%CI = −0.04 to 0.16)) and time to return of spontaneous circulation (ATE 0.023 (95% CI = 0.015–0.031)). Conclusions: IHCA is uncommon and is associated with high mortality. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with improved survival to hospital discharge were initial rhythm VT or VF, cardiac monitoring and shorter resuscitation times. [ABSTRACT FROM AUTHOR]

Objective: Survival following a traumatic cardiac arrest (TCA) remains poor despite research focused on specific management and guideline adaptation. Previous research has identified factors including age, arresting rhythm, injury severity and distance from hospital to be associated with prehospital TCA outcomes. The present study aimed to review the local incidence of TCA to inform local practice within a mature trauma system. Methods: A retrospective trauma database review from 2008 to 2021 was conducted at the Royal Brisbane and Women's Hospital. Patients were categorised by prehospital and in‐hospital arrest, prehospital return of spontaneous circulation (ROSC), and year in relation to TCA management protocol changes. Descriptive comparative analysis was performed with the primary outcome of interest being survival to hospital discharge. Results: Survival to hospital discharge was similar in patients in whom TCA occurred in the prehospital environment and hospital (24 vs 29%). Mechanism of injury, response to intervention and location of cardiac arrest were important outcome associations. Patients with a positive focused assessment with sonography in trauma scan were less likely to achieve ROSC but more likely to survive to discharge. The frequency of prehospital interventions remained similar after the guideline changes; with more patients arriving to the hospital with improved haemodynamic parameters and increased survival. Conclusions: These results support the identification and immediate management of TCA. No patients survived if they did not achieve ROSC by hospital arrival, questioning the role for aggressive management beyond the ED in this cohort. Future research will focus on the identification of patients with potentially positive survival outcomes and further define futile intervention factors. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including early steroids in traumatic haemorrhagic shock, acute superior mesenteric vessel ischaemia, and rural and remote emergency medicine.

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of venoarterial extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation or in patients with intermittent return of spontaneous circulation. This study aimed to describe the demographic characteristics and outcomes of patients undergoing ECPR to identify survival‐associated factors. Methods: The study was conducted in an extracorporeal life support centre of a tertiary hospital in Turkey and included all patients who underwent ECPR for in‐hospital cardiac arrest between April 2013 and June 2021. Complications included bleeding, neurological injury, renal failure, hepatic failure, limb ischemia and bloodstream infections. The primary outcomes were survival of ECMO and survival to discharge. Neurological outcomes were assessed using the Pediatric Cerebral Performance Category Scale for children and the Category of Cerebral Performance Scale for adults. Results: The study included 26 patients (24 paediatric, 2 adults), 22 (85%) of them had cardiac pathology. Bleeding was the most common complication. Twelve (46%) patients survived ECMO, 9 (35%) survived to discharge. Sex, age, primary diagnosis, cardiac arrest rhythm and ECMO duration were not significantly associated with the primary outcomes. Bleeding, neurological injury and renal failure were associated with poorer survival to discharge. The neurological outcomes of all survivors to discharge were good. Conclusions: ECPR is not commonly accessible. Sharing the experience of the few treating centres to date is crucial to accumulating sufficient knowledge about its efficiency and raising clinician awareness. This limited single‐centre experience demonstrated the utility of ECPR. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac arrest in pregnancy is a rare, yet extremely challenging condition to manage for all healthcare personnel involved. Knowledge deficits and poor resuscitation skills can affect outcomes in cardiac arrest in pregnancy, but research exploring healthcare personnel competence and knowledge about maternal resuscitation is limited. Aims: The aim of this study was to explore (1) healthcare personnel self‐assessed competence and knowledge about cardiopulmonary resuscitation (CPR) in pregnancy as well as perimortem caesarean section, before and after implementation of a new guideline, (2) whether there were any interprofessional differences in knowledge about maternal resuscitation, and (3) potential differences between different implementation strategies. Research Methodology: The study had a prospective repeated measure implementation design, utilizing a questionnaire before and after implementation of a new guideline on maternal resuscitation after cardiac arrest. Setting: All healthcare personnel potentially involved in CPR in six hospital wards, were invited to participate (n = 527). The guideline was implemented through either simulation, table‐top discussions and/or an electronical learning course. Results: In total, 251 (48%) participants responded to the pre‐questionnaire, and 182 (35%) to the postquestionnaire. The need for education and training/simulation concerning maternal resuscitation were significantly lowered after implementation of the guideline, yet still the majority of respondents reported a high to medium need for education and training/simulation. Participants' self‐assessed overall competence in maternal resuscitation increased significantly postimplementation. Regardless of professional background, knowledge about CPR and perimortem caesarean section increased significantly in most items in the questionnaire after implementation. Differences in level of knowledge based on implementation strategy was identified, but varied between items, and was therefore inconclusive. Conclusion: This study adds knowledge about healthcare personnel self‐assessed competence and knowledge about maternal resuscitation and perimortem caesarean section in pregnancy. Our findings indicate that there is still a need for more education and training in this rare incident. [ABSTRACT FROM AUTHOR]

The perinatal resuscitation history in Japan is short, with the earliest efforts in the field of neonatology. In contrast, the standardization and dissemination of maternal resuscitation is lagging. With the establishment of the Maternal Death Reporting Project and the Maternal Death Case Review and Evaluation Committee in 2010, with the aim of reducing maternal deaths, the true situation of maternal deaths came to light. Subsequently, in 2015, the Japan Council for the Dissemination of Maternal Emergency Life Support Systems (J‐CIMELS) was established to educate and disseminate simulations in maternal emergency care; training sessions on maternal resuscitation are now conducted in all prefectures. Since the launch of the project and council, the maternal mortality rate in Japan (especially due to obstetric critical hemorrhage) has gradually decreased. This has been probably achieved due to the tireless efforts of medical personnel involved in perinatal care, as well as the various activities conducted so far. However, there are no standardized guidelines for maternal resuscitation yet. Therefore, a committee was set up within the Japan Resuscitation Council to develop a maternal resuscitation protocol, and the Guidelines for Maternal Resuscitation 2020 was created in 2021. These guidelines are expected to make the use of high‐quality resuscitation methods more widespread than ever before. This presentation will provide an overview of the Guidelines for Maternal Resuscitation 2020. [ABSTRACT FROM AUTHOR]

Aims: The objective of this article is to summarize the state of the literature surrounding the use of ketamine as a neuroprotective agent following cardiac arrest. Methods: Five electronic databases were used to search for studies related to the use of ketamine for neuroprotection following cardiac arrest. This search was performed once in May 2020, and an updated search was conducted in May 2021 and March 2022. Results: All searches combined retrieved 181 results; no clinical trials were identified. As such, the authors were limited to writing a scoping review of the literature rather than a systematic review. Conclusions: The current state of the literature describes the mechanism of action of ketamine as a neuroprotective agent through its action as an NMDA antagonist. There is evidence of its efficacy as a neuroprotective agent in preclinical models of cardiac arrest. Current published clinical work supports the use of ketamine ameliorating neurologic outcomes in other conditions such as epilepsy, traumatic brain injury, and depression. The current state of the literature is reflective of the notion that the use of ketamine following cardiac arrest may result in improved neurologic outcomes. Future research directions should focus on the use of ketamine as a possible clinical intervention following cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: During the Coronavirus disease 2019 (COVID‐19) pandemic, hospital visits were suspended and video calls were offered to connect patients with their family members, especially toward the end of life (EoL). Aim: The primary aim was to describe EoL care for COVID‐19 patients dying in an intensive care unit (ICU). The secondary aim was to explore whether making video calls and allowing visits was associated with lower death‐related stress in family members. Design: Single centre cross‐sectional study. The setting was the ICU of a COVID‐19 center in northern Italy, during the first year of the pandemic. Data on patients who died in the ICU were collected; death‐related stress on their family members was measured using the Impact of Event Scale‐Revised (IES‐R). The statistical association was tested by means of logistic regression. Results: The study sample included 70 patients and 56 family members. All patients died with mechanical ventilation, hydration, nutrition, analgesia and sedation ongoing. Resuscitation procedures were performed in 5/70 patients (7.1%). Only 6/56 (10.7%) of the family members interviewed had visited their loved ones in the ICU and 28/56 (50%) had made a video call. EoL video calls were judged useful by 53/56 family members (94.6%) but all (56/56, 100%) wished they could have visited the patient. High‐stress levels were found in 38/56 family members (67.9%), regardless of whether they were allowed ICU access or made a video call. Compared with other degrees of kinship, patients' offspring were less likely to show a positive IES‐R score (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05 to 0.89). Conclusions: During the first year of the COVID‐19 pandemic, patients died without their family members at the bedside while on life‐sustaining treatment. Stress levels were high in most family members, especially in patients' spouses. Video calls or ICU visits were judged favourably by family members but insufficient to alleviate death‐related stress. Relevance for Clinical Practice: During a pandemic, ICU access by patients' family members should be considered, particularly as the time of death approaches. Although generally appreciated by family members, EoL video calls should be arranged together with other measures to alleviate death‐related stress, especially for the patient's spouse. [ABSTRACT FROM AUTHOR]

Background Cardiopulmonary resuscitation (CPR) training for undergraduate medical students and junior doctors has been noted to be poor in the past. Attempts have been made over the last decade to improve CPR training for all health professionals. Aim This study aimed to determine if CPR training for undergraduate medical students in a single institution improved after initial concerns in 1992, and to observe trends in CPR training over five years. Methods Prospective single centre observational cohort survey by means of a 2-page self completed questionnaire to final year undergraduate medical students at the University of Glasgow (1993–97 inclusive). Results Mean annual response rate 58% (range 48% – 67%). 99% of responders had been trained in basic life support during undergraduate training. The use of simulated arrests for training increased significantly. CPR training was concentrated in the first and final years. Training in all aspects of advanced life support increased, as did the students' confidence in these techniques. Student satisfaction with the amount of basic life support training increased very significantly and there was a small, but significant increase in student satisfaction with advanced life support training. Overall confidence at the prospect of being a member of the resuscitation team on qualification did not increase. Conclusions There has been a sustained improvement in CPR training at this institution since 1993. Improvements in the training of specific advanced life support techniques does not lead to improved overall confidence in using these skills on qualification. Advanced life support training requires further expansion. [ABSTRACT FROM AUTHOR]

Objectives Cardiac arrest is one of the leading causes of death in the United States and is treated by cardiopulmonary resuscitation ( CPR). CPR involves both chest compressions and positive pressure ventilations when given by medical providers. Mechanical chest compression devices automate chest compressions and are beginning to be adopted by emergency medical services with the intent of providing high-quality, consistent chest compressions that are not limited by human providers who can become fatigued. Biosignals acquired from cardiac arrest patients have been characterized in their ability to track the effect of CPR on the patient. The authors investigated the feasibility and appropriate response of a biosignal-guided mechanical chest compression device in a swine model of cardiac arrest. Methods After a custom signal-guided chest compression device was engineered, its ability to respond to biosignal changes in a swine model of cardiac arrest was tested. In a preliminary series of six swine, two biosignals were used: mean arterial pressure ( MAP) and a mathematical derivative of the electrocardiogram waveform, median slope (MS). How these biosignals changed was observed when chest compression rate and depth were adjusted by the signal-guided chest compression device, independent of the user. Chest compression rate and depth were adjusted by the signal-guided chest compression device according to a preset threshold algorithm until either of the biosignals improved to satisfy a set 'threshold' or until the chest compression rate and depth achieved maximum values. Defibrillation was attempted at the end of each resuscitation in an effort to achieve return of spontaneous circulation ( ROSC). Results The signal-guided chest compression device responded appropriately to biosignals by changing its rate and depth. All animals exhibited positive improvements in their biosignals. During the course of the resuscitation, three of the six animals improved their MS biosignal to reach the MS threshold, while two of the six animals improved their MAP biosignal to reach the MAP threshold. In the six experiments conducted, defibrillation was attempted on five animals, and two animals achieved ROSC. Conclusions In this proof-of-concept study, a signal-guided chest compression device was demonstrated to be capable of responding to biosignal input and delivering chest compressions with a broad range of rates and depths. [ABSTRACT FROM AUTHOR]

Background: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods: This systematic review and meta‐analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight‐step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all‐cause mortality, functional long‐term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta‐analysis, aggregate data meta‐analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. Conclusions: This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub‐groups differences. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) use in the United States occurs often in cardiothoracic ICUs (CTICU). It is unknown how it varies across ICU types. Methods: We identified 10 893 ECMO runs from the Extracorporeal Life Support Organization (ELSO) Registry across 2018 and 2019. Primary outcome was ECMO case volume by ICU type (CTICU vs. non‐CTICU). Adjusting for pre‐ECMO characteristics and case mix, secondary outcomes were on‐ECMO physiologic variables by ICU location stratified by support type. Results: CTICU ECMO occurred in 65.1% and 55.1% (2018 and 2019) of total runs. A minority of total runs related to cardiac surgery procedures (CTICU: 21.7% [2018], 18% [2019]; non‐CTICU: 11.2% [2018], 13% [2019]). After multivariate adjustment, non‐CTICU ECMO for cardiac support associated with lower 4‐ and 24‐h circuit flow (3.9 liters per minute [LPM] vs. 4.1 LPM, p < 0.0001; 4.1 LPM vs. 4.3 LPM, p < 0.0001); for respiratory support, lower on‐ECMO mean fraction of inspired oxygen ([FiO2], 67% vs. 69%, p = 0.02) and lower respiratory rate (14 vs. 15, p < 0.0001); and, for extracorporeal cardiopulmonary resuscitation (ECPR), lower ECMO flow rates at 24 h (3.5 LPM vs. 3.7 LPM, p = 0.01). Conclusions: ECMO mostly remains in CTICUs though a minority is associated with cardiac surgery. Statistically significant but clinically minor differences in on‐ECMO metrics were observed across ICU types. [ABSTRACT FROM AUTHOR]

Background: Blended learning, defined as the combination of traditional face‐to‐face instructor‐led learning and e‐learning course, has never been validated as a teaching method for the effective use of manual defibrillators in cardiopulmonary resuscitation. Aim: To evaluate whether paediatric emergency and critical care providers exposed to a blended learning session performed better and recalled more defibrillator skills than those exposed to face‐to‐face learning only. Study design: A two‐period prospective, stratified, single‐centre, simulation‐based, randomized, controlled trial. Methods: Registered nurses and postgraduate residents from either a paediatric emergency department or an intensive care unit were randomly assigned to a blended learning or face‐to‐face learning sessions on the recommended use of a manual defibrillator. Participants' adherence to recommendations was assessed by testing defibrillator skills in three consecutive paediatric cardiopulmonary scenarios performed on the day of the training and once again 2 months later. The primary endpoint was the number of errors observed during defibrillation, cardioversion, and transcutaneous pacing at the time of the initial intervention. Results: Fifty participants were randomized to receive the intervention and 51 to the control group. When pooling all three procedures, the median total errors per participant was lower (2 [IQR: 1‐4]) in providers exposed to blended learning than in those exposed to face‐to‐face learning only (3 [IQR: 2‐5]; P =.06). The median of total errors per procedure was also lower. However, both training methods appeared insufficient to maintain appropriate skill retention over time as a repetition of procedures 2 months later without any refresher learning session yielded more errors in both groups. Conclusions: Learners exposed to blended learning showed a reduced number in the total amount of errors compared with those exposed to face‐to‐face learning alone, with waning of skills over time. Relevance to clinical practice: Proficiently teaching the use of a manual defibrillator can be performed through blended learning. [ABSTRACT FROM AUTHOR]

Objective: To describe circumstances and outcomes following cardiopulmonary arrest (CPA) in hospitalized birds. Design: Retrospective case study. Setting: Academic medical center. Methods: The hospital medical records system was searched for avian cases that underwent CPR. Medical records were reviewed; data retrieved included association of CPA with anesthesia or handling, use of external compressions and intubation, drug administration, rates of return of spontaneous circulation (ROSC), and outcome. Cases with incomplete medical records were excluded. Results: Forty‐one cases of avian CPR were identified. Anesthesia‐related arrest was reported in 26 of 41 cases. The remainder of CPA events occurred during an examination (6/41) or were observed during hospitalization for treatment of disease or injury (11/41). Compressions were performed in 14 birds and manual ventilation performed in 21 of 41 cases via intubation (19/21), tight‐fitting face mask (1/21), or air sac cannulation (1/21). Vascular access was achieved in 24 of 41 cases. Emergency drug administration was documented in 22 of 41 cases and included epinephrine (20/22), atropine (19/22), glycopyrrolate (3/22), doxapram (2/22), dextrose (3/22), mannitol (1/22), and furosemide (1/22). Fluid therapy was administered in 24 of 41 cases. There were 3 documented cases of ROSC (7%), all in patients under general anesthesia, and 1 (2%) CPA survivor. Conclusions: There was no standardized approach to avian CPR in this study, and ROSC was rare. When ROSC was achieved, birds were under general anesthesia with direct monitoring by a clinician, were ventilated, and were administered anesthetic reversals and anticholinergic or catecholamine emergency medications. These poor outcomes suggest that further research and an updated standardized approach to avian CPR, with special consideration of the physiological differences from mammals, are needed. [ABSTRACT FROM AUTHOR]

Background: In selected patients with refractory out‐of‐hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta‐analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score‐matched data and comparing adults with out‐of‐hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow‐up available. Secondary outcomes were survival at the longest follow‐up available and survival at hospital discharge/30 days. Results: We included six studies, two randomized and four propensity score‐matched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%]; OR = 2.11; 95% CI, 1.41–3.15; p < 0.001, number needed to treat 16) and of survival (131/584 [22%] vs. 102/593 [17%]; OR = 1.40; 95% CI, 1.05–1.87; p = 0.02) at the longest follow‐up available compared with conventional cardiopulmonary resuscitation. Survival at hospital discharge/30 days was similar between the two groups (142/584 [24%] vs. 122/593 [21%]; OR = 1.26; 95% CI, 0.95–1.66; p = 0.10). Conclusions: Evidence from randomized trials and propensity score‐matched studies suggests increased survival and favorable neurological outcome in patients with refractory out‐of‐hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Large, multicentre randomized studies are still ongoing to confirm these findings. [ABSTRACT FROM AUTHOR]