Resuscitation
-
Randomized Controlled Trial
Chest compression quality and rescuer fatigue with increased compression to ventilation ratio during single rescuer pediatric CPR.
The effects of the recommended 30:2 compression:ventilation (C:V) ratio on chest compression rate (CR), compression depth (CD), compression pressure (CP) and rescuer fatigue is unknown during pediatric CPR. We hypothesized that a 30:2 C:V ratio will decrease compression depth and compression pressure and increase rescuer fatigue compared with a 15:2 ratio. ⋯ During single rescuer pediatric BLS, more compression cycles were achieved with 30:2 C:V ratio without effect on compression depth, pressure and rate. Increased HR with 30:2 C:V ratio was noted during larger manikin CPR without subjective difference of reported fatigue. Most rescuers in AD and TF group did not achieve recommended compression depth regardless of C:V ratio.
-
The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. ⋯ Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.
-
The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90 and 180 s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP). ⋯ ROSC and survival were equivalent regardless of VF duration and CPR duration. When CPR begins late, CPPs are low, stressing the importance of early CPR. We do not recommend 300 s of CPR unless a defibrillator is unavailable.
-
Randomized Controlled Trial
Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.
Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. ⋯ Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.
-
Randomized Controlled Trial Comparative Study
Pediatric advanced life support re-training by videoconferencing compared to face-to-face instruction: a planned non-inferiority trial.
Videoconferencing technology may be useful for providing Pediatric Advanced Life Support (PALS) re-training to geographically isolated providers. Yet, it is unclear whether learning outcomes will be similar to those obtained with traditional, face-to-face instruction. This study assess whether PALS re-training provided via live, interactive videoconferencing was as effective as the same instruction provided in a face-to-face format on PALS knowledge, psychomotor skills, and confidence in performing resuscitation skills. ⋯ For outcomes assessed following instruction and at 1 year, videoconferencing was not inferior to face-to-face delivery. These findings hold promise for use of videoconferencing to deliver PALS re-training to geographically isolated providers.