Resuscitation
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In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations. ⋯ Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.
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Accurate chest compression detection is key to evaluate cardiopulmonary resuscitation (CPR) quality. Two automatic compression detectors were developed, for the compression depth (CD), and for the thoracic impedance (TI). The objective was to evaluate their accuracy for compression detection and for CPR quality assessment. ⋯ Automatic compression detectors based on the CD and TI signals are very accurate. In most cases, episode review could safely rely on these detectors without resorting to manual review. Automatic feedback on rate can be accurately done using the impedance channel.
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Previous studies reveal pediatric resident resuscitation skills are inadequate, with little improvement during residency. The Accreditation Council for Graduate Medical Education highlights the need for documenting incremental acquisition of skills, i.e., "Milestones". We developed a simulation-based teaching approach "Rapid Cycle Deliberate Practice" (RCDP) focused on rapid acquisition of procedural and teamwork skills (i.e., "first-five minutes" (FFM) resuscitation skills). This novel method utilizes direct feedback and prioritizes opportunities for learners to "try again" over lengthy debriefing. ⋯ Implementation of the RCDP-FFM was associated with improvement in performance of key measures of quality life support and progressive acquisition of resuscitation skills during pediatric residency.
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The relationship between the neurological status at the time of handover from the ambulance crew to a Heart Attack Centre (HAC) in patients who have achieved return of spontaneous circulation (ROSC) and subsequent outcome, in the context of current treatment standards, is unknown. ⋯ Patients with shockable rhythms achieving ROSC are more likely to be conscious (A or V) compared with those with non-shockable rhythms. Most patients who are conscious on admission to the HAC will survive, compared with approximately half of those who are unconscious (P or U), suggesting that critical care is generally appropriate at all levels of consciousness if ROSC has been achieved.
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Observational Study
The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.
Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. ⋯ The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.