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Aim: Current consensus guidelines for cardiopulmonary resuscitation (CPR) recommend that chest compressions resume immediately after defibrillation attempts and that rhythm and pulse checks be deferred until completion of 5 compression:ventilation cycles or minimally for 2min. However, data specifically confirming the post-shock duration of asystole or pulseless electrical activity before return of spontaneous circulation (ROSC) are lacking. Our aim was to describe the frequency of the various post-shock cardiac rhythms and the duration of post-shock pulselessness in out-of-hospital non-traumatic cardiac arrest., Method: Using prospectively-collected data from the Resuscitation Outcomes Consortium (ROC) Epistry database, the investigators reviewed monitor-defibrillator recordings of 176 patients who received defibrillation attempts in the out-of-hospital setting for ventricular fibrillation (VF) or ventricular tachycardia (VT) with absent pulses,., Results: Among 376 different defibrillation attempts delivered in the 176 patients, there were 182 resulting episodes of post-shock asystole. The mean interval of asystole after defibrillation was 69±136s (median 20s; IQR 36) and the mean interval for return of an organized rhythm was 64±157s (median 7s; IQR 26). The mean time to ROSC was 280±320s (median 136s; IQR 445)., Conclusion: After defibrillation attempts, the majority of patients remain pulseless for over 2min and the duration of asystole before return of pulses is longer than 120s beyond the shock gap in as many as 25%. These data support the recommendation to immediately resume chest compressions for 2min following attempted defibrillation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Study Aim: The primary purpose of this study was to compare two, shorter, self-directed methods of cardiopulmonary resuscitation (CPR) education for healthcare professionals (HCP) to traditional training with a focus on the trainee's ability to perform two-person CPR., Methods: First-year medical students with either no prior CPR for HCP experience or prior training greater than 5 years were randomized to complete one of three courses: 1) HeartCode BLS System, 2) BLS Anytime, or 3) Traditional training. Only data from the adult CPR skills testing station was reviewed via video recording by certified CPR instructors and the Laerdal PC Skill Reporter software program (Laerdal Medical, Stavanger, Norway)., Results: There were 180 first-year medical students who met inclusion criteria: 68 were HeartCode BLS System, 53 BLS Anytime group, and 59 traditional group Regarding two-person CPR, 57 (84%) of Heartcode BLS students and 43 (81%) of BLS Anytime students were able to initiate the switch compared to 39 (66%) of traditional course students (p = 0.04). There were no significant differences in the quality of chest compressions or ventilations between the three groups. There was a trend for a much higher CPR skills testing pass rate for the traditional course students. However, failure to "clear to analyze or shock" while using the AED was the most common reason for failure in all groups., Conclusion: The self-directed learning groups not only had a high level of success in initiating the "switch" to two-person CPR, but were not significantly different from students who completed traditional training., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Aim of Study: To determine if a new protocol can increase the detection of agonal respirations by emergency medical dispatchers and thus the presence of cardiac arrest., Methods: This is a prospective before and after study performed in a large metropolitan city. Cases were identified by review of all cardiac arrests called into a central medical control office. Data were collected through review of tapes and documentation obtained from routine quality assurance audits of these cardiac arrests at the dispatch office as well as reports written by paramedics at the scene of each case. Data were collected for 8 months prior to and 4 months after the implementation of a new dispatcher protocol designed to identify the presence of agonal breathing which included counting the respiratory rate, holding the phone next to the patient, and identifiers used to describe this type of breathing., Results: During the 8 months prior to implementation of the new protocol, no patient had agonal respirations detected compared with 22 patients detected in the 4 months after implementation. The percentage of patients who did not have EMD criteria for cardiac arrest, but actually were in cardiac arrest decreased from 28.0% (168/599) to 18.8% (68/362; p=0.0012). Survival to ED admission was similar between the two groups. Bystanders started CPR significantly more frequently after the new protocol was instituted (60.9% before vs. 71.5% afterward, p=0.006)., Conclusion: Introduction of a new 9-1-1 dispatcher assessment protocol to assess for the presence of agonal respirations can significantly increase the detection cardiac arrest over the telephone.

Objective: A head-to-head trial was conducted to compare laypersons' long-term retention of life-saving psychomotor and cognitive skills learned in the traditional multi-hour training format for basic cardiopulmonary resuscitation and automated external defibrillator use to those learned in an abbreviated (30 min) course., Methods: Laypersons were randomized to either: (1) the traditional multi-hour Heartsaver-Automated External Defibrillator (Heartsaver-AED) group; or (2) the 30-min course group (cardiopulmonary resuscitation, choking, and automated external defibrillator use). Immediately after training, and at 6 months, participants were provided identical individual testing scenarios. In addition to audio-video recordings, computerized recordings of compression rate/depth, ventilation rates, and related pauses were obtained and subsequently rated by blinded reviewers., Results: Performance following 30-min training was either equivalent or superior (p<0.007) to the multi-hour Heartsaver-Automated External Defibrillator training in all measurements, both immediately and 6 months after training. Although retention of certain skills deteriorated over the 6 months among a significant number of participants from both groups, 84% of the 30-min training group still was judged, overall, to perform cardiopulmonary resuscitation adequately. Moreover, 93% still were performing chest compressions adequately and 93% continued to apply the automated external defibrillator and deliver shocks correctly., Conclusions: Using innovative learning techniques, 30-min cardiopulmonary resuscitation and automated external defibrillator training is as effective as traditional multi-hour courses, even after 6 months. Thirty-minute courses should decrease labor intensity, demands on resources, and time commitments for cardiopulmonary resuscitation courses, thus facilitating more widespread and frequent retraining.

Background: International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems., Methods: A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America., Results and Conclusions: Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.