Journal of Clinical Medicine

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21 pages, 529 KiB

Open AccessArticle

Assessing Attitudes and Perceptions of High-Risk, Low-Resource Communities Towards Cardiopulmonary Resuscitation and Public-Access Defibrillation

by Carolyn Hirsch, Bhanvi Sachdeva, Dilenny Roca-Dominguez, Jordan Foster, Kellie Bryant, Nancy Gautier-Matos, Mara Minguez, Olajide Williams, Mitchell S. V. Elkind, Shunichi Homma, Rafael Lantigua and Sachin Agarwal

J. Clin. Med. 2025, 14(2), 537; https://doi.org/10.3390/jcm14020537 - 16 Jan 2025

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Abstract

Background: Layperson cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are vital for improving survival rates after out-of-hospital cardiac arrest (OHCA), yet their application varies by community demographics. We evaluated the concerns and factors influencing willingness to perform CPR and use AEDs [...] Read more.

Background: Layperson cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are vital for improving survival rates after out-of-hospital cardiac arrest (OHCA), yet their application varies by community demographics. We evaluated the concerns and factors influencing willingness to perform CPR and use AEDs among laypersons in high-risk, low-resource communities. Methods: From April 2022 to March 2024, laypersons in Northern Manhattan’s Community District 12 completed surveys assessing their attitudes toward CPR and AED use before attending Hands-Only CPR training. Fisher’s Exact Test assessed differences in concerns and willingness to perform CPR and AED use across racial-ethnic groups and compared low-resource communities with high-resource groups consisting of non-clinical staff across eight ambulatory sites. Results: Among 669 participants from low-resource communities, 64% identified as Hispanic, 58% were under 40 years of age, and 67% were female. Significant knowledge gaps were identified: 62% had never learned CPR, and 77% were unfamiliar with AEDs. Top concerns about giving CPR included fear of incorrect performance (67%), causing harm (56%), and legal repercussions (53%). Willingness to perform CPR was most influenced by familiarity with the victim. The primary barrier to AED use was a lack of operational knowledge (66%). Non-Hispanic Black participants expressed significantly greater concerns than their Non-Hispanic White counterparts. Participants in high-resource settings (n = 309) showed higher training rates, albeit with similar apprehensions about CPR and AED use. Conclusions: Concerns regarding CPR and AED use stem from a lack of confidence and training, particularly predominant in certain racial-ethnic groups. Targeted, culturally sensitive community interventions could potentially address these barriers, enhance preparedness, and improve OHCA survival rates. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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10 pages, 1130 KiB

Open AccessArticle

Effectiveness of Adult Chest Compressions during Resuscitation Performed by Children Aged 10–14 Years under Simulated Conditions

by Piotr Konrad Leszczyński, Wiktoria Ciołek, Justyna Cudna and Tomasz Ilczak

J. Clin. Med. 2024, 13(19), 5933; https://doi.org/10.3390/jcm13195933 - 5 Oct 2024

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Abstract

Introduction: Numerous educational programs recommend implementing the teaching principles of BLS from an early age. The aim of this study was to evaluate selected parameters of the quality of resuscitation performed by children aged 10–14 years during simulated circulatory arrest in an adult. [...] Read more.

Introduction: Numerous educational programs recommend implementing the teaching principles of BLS from an early age. The aim of this study was to evaluate selected parameters of the quality of resuscitation performed by children aged 10–14 years during simulated circulatory arrest in an adult. Materials and Methods: The project involved four stages, culminating in students performing thoracic compressions on an adult simulator for 2 min. A digital analysis of the quality, depth, relaxation and rate of compressions allowed us to formulate results and conclusions. The authors’ proprietary questionnaire form allowed for the correlation of criteria such as age, gender, body mass and past experience in first aid training of the participant. Results: A total of 149 girls and 130 boys were studied. The mean age was 12 years (SD ± 1.41). A directly proportional increase in body mass with participant age was observed (p < 0.000). Children as young as 10 years old achieved only 24.13% quality, while those at the age of 14 demonstrated a more than doubled value (67.61%). The minimum depth of chest compressions recommended for an adult (5–6 cm) was not reached in any age group. Girls from all grades achieved a mean quality of 44.69% (SD ± 32.57), while boys achieved a score of 60.23% (SD ± 31.74). On the other hand, in the case of evaluating thoracic relaxation, a significantly better result was achieved by girls compared to boys (66.14% vs. 56.78%; rho-Spearman test for p = 0.011). Conclusions: Age, sex and body mass play important roles in the quality of resuscitation provided by children. None of the age groups studied achieved the minimum mean depth during adult thoracic compressions under simulated conditions. It is recommended to modify school-based BLS classes to better match the exercises to students’ predispositions. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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18 pages, 547 KiB

Open AccessFeature PaperArticle

Associations between Post-Intensive Care Syndrome Domains in Cardiac Arrest Survivors and Their Families One Month Post-Event

by Danielle A. Rojas, George E. Sayde, Jason S. Vega, Isabella M. Tincher, Mina Yuan, Kristin Flanary, Jeffrey L. Birk and Sachin Agarwal

J. Clin. Med. 2024, 13(17), 5266; https://doi.org/10.3390/jcm13175266 - 5 Sep 2024

Cited by 3 | Viewed by 1966

Abstract

Background: Post-intensive care syndrome (PICS) affects many critical care survivors and family members. Nevertheless, the relationship between PICS-relevant domains in cardiac arrest (CA) survivors and psychological distress in their family members (henceforth, PICS-F) remains underexplored. Methods: We enrolled consecutive CA patients [...] Read more.

Background: Post-intensive care syndrome (PICS) affects many critical care survivors and family members. Nevertheless, the relationship between PICS-relevant domains in cardiac arrest (CA) survivors and psychological distress in their family members (henceforth, PICS-F) remains underexplored. Methods: We enrolled consecutive CA patients admitted between 16 August 2021 and 28 June 2023 to an academic medical center, along with their close family members, in prospective studies. Survivors’ PICS domains were: physical dependence (Physical Self-Maintenance Scale, PSMS), cognitive impairments (Modified Telephone Interview for Cognitive Status, TICS-M), and post-traumatic stress disorder (PTSS) symptoms (PTSD Checklist—PCL 5), as well as PICS-F (PCL-5 Total Score). Hierarchical multivariate linear regressions examined associations between PICS-F and survivors’ PICS domains. Results: Of 74 dyads (n = 148), survivors had a mean (SD) age of 56 ± 16 years, with 61% being male and with a median hospital stay of 28 days. Family members (43% spouses) were slightly younger (52 ± 14 years), predominantly female (72%), and of minority race/ethnicity (62%). A high prevalence of PICS assessed 28.5 days (interquartile range 10–63) post-CA was observed in survivors (78% physical dependence, 54% cognitive impairment, 30% PTSS) and in family members (30% PTSS). Survivor PTSS was significantly associated with family member distress (β = 0.3, p = 0.02), independent of physical dependence (β = 0.0, p = 0.9), cognitive impairment (β = −0.1, p = 0.5), family member characteristics, and duration of hospitalization. Conclusions: Both CA survivors and their family members showed substantial evidence of likely PICS. Survivor PTSS is notably associated with family member distress, highlighting the need for dyadic interventions to enhance psychosocial outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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10 pages, 2260 KiB

Open AccessArticle

Optimal Positioning of Load-Distributing Band CPR Device by Body Mass Index

by Dong-gyu Kim, Eunhyang Park and Dongsun Choi

J. Clin. Med. 2024, 13(17), 5119; https://doi.org/10.3390/jcm13175119 - 29 Aug 2024

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Abstract

Background: Research investigating the optimal compression position for load-distributing bands (LDBs) in treating cardiac arrest is limited This study aimed to determine the optimal LDB position based on body mass index (BMI). Methods: A simulation study was conducted using chest and [...] Read more.

Background: Research investigating the optimal compression position for load-distributing bands (LDBs) in treating cardiac arrest is limited This study aimed to determine the optimal LDB position based on body mass index (BMI). Methods: A simulation study was conducted using chest and abdominal computed tomography imaging data collected with patients in the arms-down position. Participants were categorized into three BMI groups: low (<18.5 kg/m²), normal (18.5–25 kg/m²), and high (≥25 kg/m²). The assumed compression area was 20 cm below the axilla. The optimal compression position was identified by adjusting the axilla to maximize the thorax-to-abdomen volume ratio (TAR) and the covered heart volume ratio (CHR), defined as the ratio of heart volume compressed by the LDB to total heart volume. Optimal compression positions were compared across BMI groups. Results: Among 117 patients, TAR was significantly lower in the low BMI group compared to the normal and high BMI groups (p < 0.001), while CHR differences were not significant (p = 0.011). The distance between the optimal position and axilla height was significantly greater in the normal and high BMI groups than in the low BMI group (46.5 cm vs. 66.0 cm vs. 72 cm, respectively; p < 0.001). For each unit increase in BMI, the optimal position shifted significantly cephalad relative to axilla height (β coefficient 2.39, adjusted p < 0.001). Conclusions: Significant differences in TAR were observed among BMI groups. As BMI increased, the optimal LDB position shifted progressively cephalad. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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10 pages, 1001 KiB

Open AccessArticle

Improved Extracorporeal Cardiopulmonary Resuscitation (ECPR) Outcomes are Associated with a Restrictive Patient Selection Algorithm

by Benjamin Assouline, Nathalie Mentha, Hannah Wozniak, Viviane Donner, Carole Looyens, Laurent Suppan, Robert Larribau, Carlo Banfi, Karim Bendjelid and Raphaël Giraud

J. Clin. Med. 2024, 13(2), 497; https://doi.org/10.3390/jcm13020497 - 16 Jan 2024

Cited by 4 | Viewed by 2475

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence [...] Read more.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence from recent randomized controlled trials yielded contradictory results, and the criteria for selecting eligible patients are still a subject of debate. Methods: This study is a retrospective analysis of refractory OHCA patients treated with ECPR. All adult patients who received ECPR, according to the hospital algorithm, from 2013 to 2021 were included. Two different algorithms were used during this period. A “permissive” algorithm was used from 2013 to mid-2016. Subsequently, a revised algorithm, more “restrictive”, based on international guidelines, was implemented from mid-2016 to 2021. Key differences between the two algorithms included reducing the no-flow time from less than three minutes to zero minutes (implying that the cardiac arrests must occur in the presence of a witness with immediate CPR initiation), reducing low-flow duration from 100 to 60 min, and lowering the age limit from 65 to 55 years. The aim of this study is to compare these two algorithms (permissive (1) and restrictive (2)) to determine if the use of a restrictive algorithm was associated with higher survival rates. Results: A total of 48 patients were included in this study, with 23 treated under Algorithm 1 and 25 under Algorithm 2. A significant difference in survival rate was observed in favor of the restrictive algorithm (9% vs. 68%, p < 0.05). Moreover, significant differences emerged between algorithms regarding the no-flow time (0 (0–5) vs. 0 (0–0) minutes, p < 0.05). Survivors had a significantly shorter no-flow and low-flow time (0 (0–0) vs. 0 (0–3) minutes, p < 0.01 and 40 (31–53) vs. 60 (45–80) minutes, p < 0.05), respectively. Conclusion: The present study emphasizes that a stricter selection of OHCA patients improves survival rates in ECPR. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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20 pages, 1121 KiB

Open AccessFeature PaperArticle

Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study

by Georg Trummer, Christoph Benk, Jan-Steffen Pooth, Tobias Wengenmayer, Alexander Supady, Dawid L. Staudacher, Domagoj Damjanovic, Dirk Lunz, Clemens Wiest, Hug Aubin, Artur Lichtenberg, Martin W. Dünser, Johannes Szasz, Dinis Dos Reis Miranda, Robert J. van Thiel, Jan Gummert, Thomas Kirschning, Eike Tigges, Stephan Willems, Friedhelm Beyersdorf and on behalf of the Extracorporeal Multi-Organ Repair Study Group Show full author list Hide full author list

J. Clin. Med. 2024, 13(1), 56; https://doi.org/10.3390/jcm13010056 - 21 Dec 2023

Cited by 6 | Viewed by 7779

Abstract

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment [...] Read more.

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues. Methods: This all-comers, multicenter, prospective observational study (69 patients with in- and out-of-hospital CA (IHCA and OHCA) after prolonged refractory CCPR) focused on extracorporeal cardiopulmonary support, comprehensive monitoring, multi-organ repair, and the potential for out-of-hospital cannulation and treatment. Result: The overall survival rate at hospital discharge was 42.0%, and a favorable neurological outcome (CPC 1+2) at 90 days was achieved for 79.3% of survivors (CPC 1+2 survival 33%). IHCA survival was very favorable (51.7%), as was CPC 1+2 survival at 90 days (41%). Survival of OHCA patients was 35% and CPC 1+2 survival at 90 days was 28%. The subgroup of OHCA patients with pre-hospital cannulation showed a superior survival rate of 57.1%. Conclusions: This new strategy focusing on repairing damage to multiple organs appears to improve outcomes after CA, and these findings should provide a sound basis for further research in this area. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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Review

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15 pages, 648 KiB

Open AccessReview

Seeking a Treatable Cause of Out-of-Hospital Cardiac Arrest during and after Resuscitation

by Saleem M. Halablab, William Reis and Benjamin S. Abella

J. Clin. Med. 2024, 13(19), 5804; https://doi.org/10.3390/jcm13195804 - 28 Sep 2024

Viewed by 1797

Abstract

Out-of-hospital cardiac arrest (OHCA) represents a significant global public health burden, characterized by low survival and few established diagnostic tools to guide intervention. OHCA presents with a wide variety of etiologies in a heterogeneous population, posing a clinical challenge to care teams. In [...] Read more.

Out-of-hospital cardiac arrest (OHCA) represents a significant global public health burden, characterized by low survival and few established diagnostic tools to guide intervention. OHCA presents with a wide variety of etiologies in a heterogeneous population, posing a clinical challenge to care teams. In this review, we describe evolving research focused on diagnostic approaches to OHCA following resuscitation, including electrocardiography, coronary angiography, computed tomography, ultrasonography, and serologic biomarker assessment. These diagnostic tools have been employed in post-resuscitative efforts for diagnosing ischemic and non-ischemic cardiac, respiratory, neurologic, vascular, traumatic, and metabolic causes of arrest. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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20 pages, 2558 KiB

Open AccessReview

Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest

by Samuel Bernard, Raymond A. Pashun, Bhavya Varma and Eugene Yuriditsky

J. Clin. Med. 2024, 13(12), 3527; https://doi.org/10.3390/jcm13123527 - 16 Jun 2024

Cited by 1 | Viewed by 5534

Abstract

Given the high morbidity and mortality associated with cardiopulmonary arrest, there have been multiple trials aimed at better monitoring and augmenting coronary, cerebral, and systemic perfusion. This article aims to elucidate these interventions, first by detailing the physiology of cardiopulmonary resuscitation and the [...] Read more.

Given the high morbidity and mortality associated with cardiopulmonary arrest, there have been multiple trials aimed at better monitoring and augmenting coronary, cerebral, and systemic perfusion. This article aims to elucidate these interventions, first by detailing the physiology of cardiopulmonary resuscitation and the available tools for managing cardiopulmonary arrest, followed by an in-depth examination of the newest advances in the monitoring and delivery of advanced cardiac life support. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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