Search Results (253)

Background/Objectives: Initial cardiac rhythm is a known prognostic indicator in out-of-hospital cardiac arrest (OHCA). However, the impact of rhythm conversion during cardiopulmonary resuscitation (CPR) on outcomes in patients undergoing extracorporeal CPR (ECPR) remains unclear. This study evaluated the association between initial and converted cardiac rhythms and outcomes in patients with refractory OHCA treated with ECPR. Methods: This nationwide retrospective observational study analyzed data from the Out-of-Hospital Cardiac Arrest Surveillance registry in South Korea (2008–2022). Patients were categorized into three groups: initial shockable rhythm (SR), non-shockable rhythm (NSR) converted to SR, and refractory NSR. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological status (CPC 1–2). Results: Among 681 patients, 161 had initial SR, 345 had converted SR, and 175 had refractory NSR. Before matching, survival and CPC 1–2 rates were highest in the initial SR group (21.1% and 15.5%), followed by the converted SR group (19.4% and 11.6%), and lowest in the refractory NSR group (9.7% and 4.0%) (p < 0.01). After matching, CPC 1–2 remained significantly higher in the initial SR group (14.4%) and in the converted SR group (9.3%) vs. the refractory NSR group (5.1%, p = 0.016; 3.7%, p = 0.042). Persistent NSR was independently associated with poor neurological outcomes compared to both initial SR (AOR 0.337, p = 0.037) and converted SR (AOR 0.283, p = 0.020). Conclusions: Rhythm conversion from NSR to SR before ECPR was associated with significantly improved neurological outcomes. Rhythm conversion may serve as a prognostic marker and resuscitation target to guide ECPR decisions. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article

Aim: The present study evaluated the feasibility and quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer, comparing the over-the-head (OTH) technique using mouth-to-pocket mask ventilation with bag-valve mask (BVM) ventilation. The study analyzed the chest compression (CC) quality, ventilation adequacy, interruption minimization, and the rescuers’ perceived difficulty. Methods: A randomized simulation crossover study was conducted with 26 lifeguard students trained in basic life support and both ventilation techniques. All of the participants performed two solo CPR trials (2 min each) using OTH with a pocket mask or BVM on a manikin connected to a feedback system (Little Anne QCPR, Laerdal). The overall CPR quality, ventilation, and CC quality were assessed, along with the perceived difficulty (scale 0–5). A 5 min rest was provided between the trials. Results: The overall CPR quality was excellent for both techniques with a median of 98% (IQR: 97–99) for BVM-OTH and 99% (IQR: 94–99) for Pocket-OTH (p = 0.31). The ventilation quality was better when using BVM-OTH (100%, IQR: 99–100) compared to that with Pocket-OTH (99%, IQR: 77–100; p = 0.046). No differences were found in the CC quality (99%, IQR: 99–100; p = 0.24). However, Pocket-OTH had more CCs and shorter interruption times (p ≤ 0.001). The perceived difficulty was low for both techniques. Conclusions: Both techniques enable high-quality CPR when performed alone. Given that no clinically relevant differences emerged in the resuscitation quality, the OTH technique using a pocket mask offers a viable alternative, particularly in scenarios with a single rescuer and limited resources. Full article

Background: Professional knowledge and experience of healthcare organization went through continuous change and development with the progression of COVID-19 pandemic waves. However, carefully developed guidelines for cardiopulmonary resuscitation (CPR) remained largely unchanged regardless of the epidemic situation, with the largest change being a more prominent bioethical approach. It would be possible to further improve the quality of CPR by systematic data collection, the facilitation of prospective studies, and further development of the methodology based on this evidence, as well as by providing information and developing provisions on interventions with expected poor outcomes, and ultimately by refusing resuscitation. Methods: This study involved the critical collection and analysis of literary data originating from the Web of Science and PubMed databases concerning bioethical aspects and the efficacy of CPR during the COVID-19 pandemic. Results: According to the current professional recommendation of the European Resuscitation Council (ERC), CPR should be initiated immediately in case of cardiac arrest in the absence of an exclusionary circumstance. One such circumstance is explicit refusal of CPR by a well-informed patient, which in practice takes the form of a prior declaration. ERC prescribes the following conjunctive conditions for do-not-attempt CPR (DNACPR) declarations: present, real, and applicable. It is recommended to take the declaration as a part of complex end-of-life planning, with the corresponding documentation available in an electronic database. The pandemic has brought significant changes in resuscitation practice at both lay and professional levels as well. Incidence of out-of-hospital resuscitation (OHCA) did not differ compared to the previous period, while cardiac deaths in public places almost halved during the epidemic (p < 0.001) as did the use of AEDs (p = 0.037). The number of resuscitations performed by bystanders and by the emergency medical service (EMS) also showed a significant decrease (p = 0.001), and the most important interventions (defibrillation, first adrenaline time) suffered a significant delay. Secondary survival until hospital discharge thus decreased by 50% during the pandemic period. Conclusions: The COVID-19 pandemic provided a significant impetus to the revision of guidelines. While detailed methodology has changed only slightly compared to the previous procedures, the DNACPR declaration regarding self-determination is mentioned in the context of complex end-of-life planning. The issue of safe environment has come to the fore for both lay and trained resuscitators. Future Directions: Prospective evaluation of standardized methods can further improve the patient’s autonomy and quality of life. Since clinical data are controversial, further prospective controlled studies are needed to evaluate the real hazards of aerosol-generating procedures. Full article

Background/Objectives: In this study, we aimed to analyze the validity, based on the internal structure of the construct, measurement invariance by sex, and reliability of the scores for the “Knowledge in Basic Cardiopulmonary Resuscitation in Peruvian children/adolescents” (KBCPR_P21) and “Attitudes in Basic Cardiopulmonary Resuscitation in Peruvian children/adolescents” (ABCPR_P21) instruments in Spanish. Methods: A cross-sectional and instrumental methodological study was conducted between February and August 2021, with the participation of 415 Peruvian elementary school students between 8 and 13 years of age. Participants responded to surveys on knowledge and attitudes toward CPR. For both instruments, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was used as the estimation method for categorical data. Results: All of the items for both scales have high discriminative capacity (>0.30), and both scales showed high internal consistency (Cronbach’s alpha > 0.87 and McDonald’s omega > 0.90). The validity, based on the internal structure of the construct, implied the existence of a single factor grouping all the items in the two scales (CFI and TLI > 0.95; RMSEA and SRMR < 0.08). Multigroup confirmatory factor analysis also allowed us to satisfactorily verify measurement invariance by sex at the four levels (configural, metric, scalar, and strict) for both scales. Conclusions: We can conclude that the values obtained in our evaluation of the scales favor considering them as valid and reliable instruments with which to measure knowledge and attitudes toward basic cardiopulmonary resuscitation in children/adolescents in Peru, given prior learning. The scales could also be used in the evaluation of knowledge and attitudes around basic cardiopulmonary resuscitation in other countries, providing trainers with rapid feedback on the knowledge and attitudes transmitted in training courses, thus allowing better control over the training activities carried out in these courses. Finally, the availability of the scales would allow researchers to empirically test their psychometric properties in other countries. Full article

Background/Objectives: Near-infrared spectroscopy (NIRS) enables the non-invasive assessment of cerebral oximetry, offering insights into the efficacy of oxygen supply to the brain. NIRS, when combined with other monitoring techniques such as capnography, may play a crucial role in advanced patient monitoring during sudden cardiac arrest and post-resuscitation treatment. This research assessed the relationship between end-tidal carbon dioxide (ETCO₂) and regional cerebral oxygen saturation (rSO₂) during cardiopulmonary resuscitation. Methods: The research was performed from 11 January 2023 until 31 January 2024, at the University Hospital in Poland. The cohort of responders included patients who had in-hospital cardiac arrest (IHCA). The Rapid Response Team attached the rSO₂ and ETCO₂ monitoring devices to each patient during cardiopulmonary resuscitation (CPR). The cohort included 104 patients. Results: The correlation coefficient between ETCO₂ and rSO₂ values was 0.641 (95% CI: 0.636–0.646), and during the last 4 min of CPR before ROSC, it was 0.873 (95% CI: 0.824–0.910). Conclusions: The positive correlation between ETCO₂ and rSO₂ may suggest that concurrent monitoring of both parameters during resuscitation might serve as a valuable predictor of CPR efficacy and the likelihood of achieving recovery of spontaneous circulation in a multimodal framework. In the lack of rapid ETCO₂ monitoring capabilities, rSO₂ may function as a simple and effective alternative for assessment. Full article

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is a method for initiation of cardiopulmonary bypass during resuscitation of a patient with refractory cardiac arrest to support end-organ perfusion. This retrospective study evaluates which prognostic markers are seen in patients with poor outcomes who underwent eCPR in our rural tertiary care center. Study Design/Methods: All patients who underwent eCPR at our center from May 2013 to January 2023 were analyzed in a retrospective manner. We then compared outcomes in patients who survived to discharge (survivors) versus those who did not survive to discharge (non-survivors). Demographic factors, body mass index, peak serum lactate in 24 h, initial rhythm, lowest mean arterial pressure within the first six hours, a requirement of renal replacement therapy, and the number of blood transfusions required during the hospitalization were analyzed. Results: 37 patients (24 males and 13 females) with a median age of 58 years (IQR: 48–65) were included. The overall mortality rate was 75.7%, and all survivors had good neurological outcomes, which were defined as Cerebral Performance Category (CPC) scores of 1 or 2. The most significant factors seen in non-survivors were obesity as measured by BMI more than 30 (odds ratio = 7.33; 95% CI 1.40–38.33; p = 0.02), and lowest MAP <65 within the first 6 h despite being on extracorporeal membrane oxygenation (0% vs. 74.1%; p = <0.01). Conclusions: This retrospective study demonstrates that initial presentations of patients who underwent eCPR with obesity and MAPS < 65 within the first 6 h despite ECMO support were seen in patients with higher mortality. Full article

Background/Objectives: Performing cardiopulmonary resuscitation (CPR) is cognitively demanding, often requiring helpers to perform cognitive and manual tasks simultaneously. While the human brain primarily switches between tasks rather than processing them simultaneously, it remains unclear whether performing repetitive, monotonous manual tasks, such as chest compressions, affects cognitive performance. This study aimed to assess the impact of chest compressions on mental arithmetic performance. Methods: In a randomized crossover trial, healthy participants trained in advanced life support (physicians, nurses, and paramedics) completed the Paced Auditory Serial Addition Test (PASAT) under two conditions: with or without performing chest compressions on a manikin. The primary outcome was the number of correct PASAT answers. Secondary outcomes included workload assessment using the NASA Task Load Index (TLX) and chest compression (CC) performance. The trial was registered at clinicaltrials.gov and approved by the local ethics committee. Results: Thirty-eight participants were included. The number of correct PASAT responses was significantly lower during chest compressions compared to the control (36.5 vs. 41; p < 0.01). NASA TLX values were significantly higher in the chest compression condition, indicating increased perceived workload. Chest compression performance showed statistically significant differences between a phase of just chest compressions and during the PASAT, especially increased levels of incomplete recoil. Conclusions: This study demonstrates that even a simple repetitive motor task like chest compressions impairs cognitive task performance significantly. Furthermore, multitasking was shown to decrease chest compression quality. These findings strongly highlight the importance of effective task allocation and minimizing multitasking during CPR to optimize performance and thereby patient outcomes. Full article

Service learning across medical schools is non-standardized and the skills that they learn can vary. Project HEART, a volunteer-based outreach program focused on teaching cardiovascular health and cardiopulmonary resuscitation (CPR) at public high schools, was implemented to encourage greater community engagement and equilibrate skill acquisition across different service projects. This pilot study characterized the benefits of providing service learning opportunities to first-year medical students. First-year medical students at a single institution were recruited to Project HEART. Following service sessions, all students completed a retrospective pre/post survey. They provided self-reported scores on a five-point Likert-type scale, grading their didactic and communication skills before and after the event. Subjective feelings of community engagement were also queried. Overall, 30 students were recruited across nine different community programs. Following participation, significantly increased confidence was seen in performing hands-only CPR (p < 0.001), public speaking (p = 0.003), teaching effectively (p < 0.001), and explaining medical terminology to laypersons (p < 0.001). Volunteers had an increased sense of community engagement (p < 0.001) and 17/30 students expressed greater consideration towards specializing in cardiology, primary care, or entering academia after participation. The study supported the proposal that service learning may promote self-determined altruism, positively influence perceptions of community stewardship, and have positive subjective benefits on medical student education. Full article

Objectives: The objectives of this study were to determine the suitability of the low-fidelity/low-cost simulator “Salvando a Rosita^®” in the acquisition of “hands-only CPR” skills by adult nursing degree students. Methods: A quasi-experimental quantitative study was carried out with a single experimental group that included 89 nursing degree students; it was conducted in November and December 2024 at the National University of Trujillo, Peru. Results: The STAI-TA score was 17.30, and the STAI-SA score was 37.00 points. Women showed a greater level of SA (p = 0.002). The required effort was described by women as being high and by men as light (p < 0.001). The compression rate was 125.7, and the percentage of compressions with an adequate depth was 89.6%. Overweight/obese individuals achieved more correct compressions (p < 0.01). The attitudes toward alerting emergency services, remaining calm while a person is in cardiac arrest, applying the CPR sequence automatically, and performing CCs were better after receiving training. The majority considered the “Salvando a Rosita^®” simulator to be useful for teaching “hands-only CPR” to students in the first cycles of a nursing degree. Conclusions: The “Salvando a Rosita^®” simulator was found to be an appropriate tool for teaching “hands-only CPR” to students in either the first cycles of health sciences or in other related professions. Full article

Background: Appropriate clinical training for emergencies is a key factor in the quality of healthcare. Advances in technology facilitate the creation of new forms of training, fostering student interaction and engagement. In this respect, augmented and virtual reality approaches in healthcare training are generating great interest. Objectives: to evaluate the effectiveness of virtual and augmented reality in emergency healthcare training. Methods: A randomized controlled trial was conducted with two intervention groups. Intervention group No. 1 (n = 30) received in-class instruction followed by practice with a cardiopulmonary resuscitation (CPR) manikin and using virtual reality with the Meta Quest model (using the VR applications Heart, Lung, and School of CPR). Intervention group No. 2 (n = 31) received the same in-class training but followed by an augmented reality session. In this intervention, the Heart and Lung AR applications were used on an iPhone 15 ProMax. The control group (n = 32) only received in-class instruction and practice with the CPR manikin. Results: The virtual reality and augmented reality interventions improved learning effectiveness and user satisfaction. These results were statistically significant (p < 0.05) for knowledge post-intervention between groups, VR being the highest. However, the results were not significant for satisfaction. Conclusions: VR procedures can be effective for increasing learning effectiveness in emergency training. Full article

To develop and evaluate deep learning models for cardiac arrest rhythm classification during cardiopulmonary resuscitation (CPR), we analyzed 508 electrocardiogram (ECG) segments (each 4 s in duration, recorded at 250 Hz) from 131 cardiac arrest patients. Compression-affected segments were recorded during chest compressions, while non-compression segments were extracted during compression pauses or immediately after return of spontaneous circulation (ROSC) declaration. One-dimensional convolutional neural network (1D-CNN) and recurrent neural network (RNN) models were employed for four binary classification tasks: (1) shockable rhythms (VF and pVT) versus non-shockable rhythms (asystole and PEA) in all ECG segments; (2) the same classification in compression-affected ECG segments; (3) pulse-generating rhythms (ROSC rhythm) versus non-pulse-generating rhythms (asystole, PEA, VF and pVT) in all ECG segments; and (4) the same classification in compression-affected ECG segments. The 1D-CNN model consistently outperformed the RNN model across all classification tasks. For shockable versus non-shockable rhythm classification, the 1D-CNN achieved accuracies of 91.3% and 89.8% for all ECG segments and compression-affected ECG segments, respectively, compared to 50.6% and 54.5% for the RNN. In detecting pulse-generating rhythms, the 1D-CNN demonstrated accuracies of 90.9% and 85.7% for all ECG segments and compression-affected ECG segments, respectively, while the RNN achieved 92.2% and 84.4%. The 1D-CNN model demonstrated superior performance in cardiac arrest rhythm classification, maintaining high accuracy even with compression-affected ECG data. Full article

Background/Objectives: Pediatric cardiac arrest poses considerable obstacles, with survival rates markedly inferior to those of adults. Effective chest compressions are essential for enhancing outcomes; nevertheless, the ideal rescuer attitude is still ambiguous. This study sought to compare the efficacy of lateral (LAT) and over-the-head (OTH) chest compression techniques in pediatric cardiopulmonary resuscitation (CPR) and to ascertain whether OTH presents a viable alternative to the conventional LAT method by assessing compression quality, rescuer fatigue, and ergonomics. Methods: A randomized crossover simulation study was conducted in a high-fidelity medical simulation facility. Thirty-five medical students executed 2 min cycles of chest compressions with both LAT and OTH techniques, interspersed with a 15 min rest period between sessions. Results: OTH showed a tendency for enhanced overall performance (72.94 vs. 64.46; p = 0.08), while the differences lacked statistical significance. The compression rate was somewhat elevated with OTH (116.94 compared to 114.57; p = 0.31). We assessed LAT as somewhat less challenging (4.37 vs. 3.91; p = 0.17) and found less fatigue (4.83 vs. 4.40; p = 0.24). Male rescuers and individuals with elevated BMI attained larger compression depths. Age was negatively connected with the ease and efficiency of compressions. Conclusions: Although no statistically significant differences were detected, OTH demonstrated potential for enhanced performance. The anthropometrics of rescuers affected the quality of CPR, highlighting the necessity for tailored training methods. Future investigations should examine the long-term viability of OTH in clinical and pre-hospital environments. Full article

Background/Objectives: The aim of this study was to determine the optimal ventilation mode during cardiopulmonary resuscitation (CPR) by comparing the effects of chest compression-synchronized ventilation (CCSV) and intermittent positive-pressure ventilation (IPPV) on arterial blood gases. Methods: This prospective randomized controlled study included patients presenting with out-of-hospital cardiac arrest who were randomly assigned to the CCSV or IPPV groups. Arterial blood gas analysis was performed at the start of CPR and 10 min after initiating mechanical ventilation. Primary outcomes included changes in the arterial oxygen and carbon dioxide pressures. Results: Of the 144 patients with out-of-hospital cardiac arrest, 30 were included in the study, with 15 each assigned to the CCSV and IPPV groups. The median arterial oxygen pressure in the CCSV group was 76.1 [22.8; 260.3 interquartile range], compared with 8.8 [−1.6; 113.9 interquartile range] in the IPPV group (p = 0.250). The change in carbon dioxide pressure was −10.3 [−18.3; −2.7 interquartile range] in the CCSV group and −11.5 [−39.5; 5.6 interquartile range] in the IPPV group (p = 0.935). Wilcoxon signed-rank test results revealed significant differences in arterial oxygen and carbon dioxide pressure levels before and after treatment in the CCSV group (p = 0.026 and 0.048, respectively). However, in the IPPV group, changes in arterial partial pressure of oxygen and carbon dioxide before and after treatment were non-significant (p = 0.095 and 0.107, respectively). Conclusions: Although CCSV significantly improved oxygenation and ventilation in patients undergoing CPR, it cannot be considered superior to IPPV. Full article