Search Results (95)

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: Assisted reproductive technologies (ARTs) are essential in treating infertility but often face limited success due to low implantation and live birth rates. East Asian traditional medicine (EATM), including acupuncture and herbal medicine (HM), may enhance physiological responses during ART cycles. This study evaluated the effectiveness and safety of EATM in improving clinical pregnancy and live birth outcomes in women undergoing ART. Methods: This review, registered in PROSPERO (CRD42023411712), systematically searched 11 databases up to 31 March 2023. We included randomized controlled trials (RCTs) comparing EATM interventions to control groups. Data extraction and quality assessment were performed independently by two authors. Meta-analysis used the inverse-variance method in Stata 12.0. A total of 37 RCTs involving 10,776 women (aged 29–38) were analyzed. Studies addressed infertility causes including polycystic ovary syndrome, tubal blockage, diminished ovarian reserve, and unexplained infertility. Acupuncture therapies included body, electro-, laser, and auricular acupuncture. Herbal treatments were administered as powders, pills, granules, decoctions, and ointments based on traditional Chinese formulas. Results: EATM interventions were associated with significant improvements in clinical pregnancy and live birth rates. Acupuncture increased clinical pregnancy rates (CPR: RR 1.316, 95% CI 1.171–1.480) and live birth rates (LBR: RR 1.287, 95% CI 1.081–1.533). HM also enhanced CPRs (RR 1.184) and LBRs (RR 1.147). Subgroup analysis showed true acupuncture and HM were more effective than sham or placebo. No significant differences in adverse events were found. Conclusions: EATM, particularly acupuncture and HM, appears to be a safe and effective complementary therapy that can be used to improve ART outcomes. Future research should focus on developing standardized acupuncture and herbal protocols to optimize integration with ART. Full article

Background: Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3–5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo implantation or pregnancy viability. Uterus transplantation (UTx) has emerged as a promising treatment for AUFI and has been successfully performed in over 10 countries. Objectives: This study aims to conduct a systematic review of uterus transplantation, evaluating its efficacy and safety, as well as maternal, neonatal, and long-term outcomes. It also explores current challenges and future directions. Methods: The methodology was registered on the PROSPERO platform. A literature search was performed in January 2025 across PubMed, Web of Science, and Scopus for articles published from January 2002 to December 2024 in English or Portuguese. The query was: “uterus/transplantation AND (pregnancy OR complications OR newborn OR premature OR diseases)”. Study quality was assessed by journal impact factor (IF). Data were analyzed using Microsoft Excel. Results: A total of 10 studies were included: four from Sweden, three from the DUETS group, two from the Czech Republic, and one multi-institutional American study. The UTx success rate was 74.0%; clinical pregnancy rate (CPR) and live birth rates (LBR) per embryo transfer (ET) were 36.3% and 22.0%, respectively. No significant increase in congenital or neurological complications was observed. Adverse psychological outcomes were associated with transplant failure or pregnancy loss. Conclusions: UTx is a promising treatment for AUFI, showing favorable pregnancy and birth outcomes without major fetal or neonatal risks. 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

Background: First aid training in secondary education enhances emergency preparedness and supports public health. Despite its inclusion in many school curricula, there is no consensus on the most effective teaching methodologies. This systematic review aims to compare instructional strategies used in first aid training during Physical Education and evaluate their impact on students’ knowledge, practical skills, and confidence. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases (SCOPUS, Web of Science, ERIC, DIALNET, MEDLINE, and PsycINFO) were searched up to December 2024. Eligible studies were quasi-experimental or observational, involved students aged 11–18, and focused on first aid instruction within Physical Education. Methodological quality was assessed using the PEDro scale. Results: Eleven studies with a total of 3069 students aged 11–18 were included. Active and technology-based methodologies outperformed traditional approaches, improving knowledge acquisition (10.2–30.5%) and practical skill development (18.6–42.3%). Long-term retention ranged from 14.2% to 45.8%, with longer interventions yielding better outcomes. Gamification, simulations, and peer learning improved CPR quality and boosted student confidence. However, most studies assessed only short-term outcomes, limiting conclusions about sustained learning. Conclusions: Active methodologies, particularly gamification, simulation, and cooperative learning, enhance knowledge retention, practical skills, and confidence in providing first aid. Although the results were consistently positive, methodological heterogeneity and limited long-term follow-up reduce their generalizability. Further high-quality, longitudinal research is needed to identify the most effective and sustainable strategies. These findings support integrating first aid training into Physical Education as a public health initiative to strengthen emergency preparedness in schools. 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

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: Effective infant cardiopulmonary resuscitation (CPR) relies on high-quality chest compressions, yet the optimal technique for single-rescuer scenarios remains debated. Although widely used, the two-finger technique (TFT) is associated with an inadequate compression depth and increased rescuer fatigue. While the two-thumb encircling hands technique (TTHT) provides a superior compression depth, its application in single-rescuer scenarios is impractical. This study evaluates a novel technique (nT) as a potential alternative, aiming to optimize both compression efficacy and rescuer endurance. Methods: This randomized crossover study assessed the efficacy of the TFT, TTHT, and nT in a simulated infant CPR setting. Medical students trained in newborn and infant resuscitation performed all three techniques in a controlled environment using a high-fidelity neonatal simulator. We objectively measured and compared key CPR performance metrics, rescuer fatigue, and hand pain among the techniques. Results: The nT and TTHT outperformed the TFT in compression depth, rescuer endurance, and overall CPR quality. The nT achieved the highest adequate compression rate (92.4% vs. 78.6% for TTHT and 65.2% for TFT) while minimizing fatigue (RPE: 3.1 vs. 4.5 for TTHT and 6.2 for TFT) and hand pain (NRS: 1.8 vs. 3.9 for TTHT and 5.4 for TFT). TTHT produced the deepest compressions (mean: 44.2 mm vs. 42.9 mm for nT and 38.6 mm for TFT, p < 0.001). Rescuer anthropometric factors (sex, weight, and height) affected all techniques similarly, suggesting no inherent advantage based on body characteristics. Conclusions: Both the nT and TTHT outperformed the TFT, with the nT demonstrating superior rescuer endurance while maintaining high-quality compressions. Given its ergonomic benefits and effectiveness, the nT emerges as a promising alternative for single-rescuer infant CPR and warrants consideration for future resuscitation guidelines. Full article

Background/Objectives: The COVID-19 pandemic has highlighted the challenges faced by essential professionals, such as nurse managers and early childhood educators (ECEs), who grapple with heightened stress, burnout, and compassion fatigue. In response, the Compassion, Practice, Relationships, and Restoration (CPR²) program was designed as a virtual, structured wellness intervention to address these pressing concerns among caregiving professionals. Methods: A mixed-methods study was employed to evaluate the feasibility, acceptability, and preliminary outcomes of CPR², implemented across two cohorts: nurse managers in a pediatric hospital and early childhood educators (ECEs) serving equity-deserving communities. Participants completed electronic surveys at pre- and post-test assessing mindfulness, professional quality of life, healthy lifestyle behaviors, and perceived social cohesion. One month post-program, focus groups were conducted using a facilitation guide to evaluate program elements, including group structure, expectations, discussion themes, and sustainability. Results: Quantitative findings suggest that while nurse managers experienced significant reductions in compassion fatigue, along with improvements in mindfulness and perceived cohesion, ECEs exhibited stable levels of stress and burnout. Both cohorts reported enhanced sleep quality, emphasizing the program’s potential to foster critical aspects of wellbeing. Qualitative participant feedback highlighted the importance of organizational readiness, leadership engagement, and program flexibility for successful implementation. Conclusions: The study highlights the need for tailored, context-sensitive wellness interventions that recognize the unique challenges faced by different caregiving roles. It also emphasizes the potential for sustained impact when wellness initiatives are integrated into the organizational culture, further reinforcing the importance of ongoing commitment to workforce wellbeing in high-stress environments. Full article

Straw incorporation offers significant advantages in agricultural crop cultivation systems. Mechanized methods constitute the predominant approach, potentially reducing yield costs and enhancing operational efficiency. The imperative to enhance the quality of straw chopping within the field is of particular significance, as suboptimal chopping quality can engender a cascade of issues, particularly seeding blockages. The straw chopping pass rate (CPR) is a pivotal metric for assessing the quality of straw chopping. Therefore, enhancing the CPR during the straw chopping process is necessary. This study introduces a novel maize-straw-chopping device with the ground as its supporting base. This device facilitates the rapid vertical chopping of maize straw through a constant breath cam transmission mechanism. Critical parameters were determined to optimize the performance of the chopping device by establishing mathematical models and kinematic simulation analysis methods. With the help of Rocky 2022.R2 software, the influence of the rotational velocity of the draft, tractor velocity, and blade edge angles on the CPR during the operation of the device was analyzed. The Box–Behnken test methodology was used to carry out a three-factor, three-level orthogonal rotation test to obtain the optimal working parameter combination. The results indicated that the maximum CPR value was achieved with a draft rotational velocity of 245 rpm, a tractor velocity of 3.8 km/h, and a blade edge angle of 20.75°. Finally, field validation experiments were conducted under these optimized conditions, with the average CPR of maize straw reaching an impressive 91.45%. These findings have significant implications for enhancing crop production practices. Full article

Background: This study aimed to assess the feasibility and quality of resuscitation maneuvers performed on a newborn over the mother’s body while maintaining SSC and delayed cord clamping. Methods: A randomized crossover manikin study compared standard cardiopulmonary resuscitation (Std-CPR) and cardiopulmonary resuscitation during SSC (SSC-CPR). Nursing students (n = 40) were recruited and trained in neonatal CPR. The quality of the CPR, including compression and ventilation variables, was evaluated using Laerdal Resusci Baby QCPR^® manikins. Findings: No significant differences were found in the compression variables between the Std-CPR and the SSC-CPR. The quality variables demonstrated comparable results between the two techniques. The quality of the compressions showed medians of 74% for the Std-CPR and 74% for the SSC-CPR (p = 0.79). Similarly, the quality of the ventilations displayed medians of 94% for the Std-CPR and 96% for the SSC-CPR (p = 0.12). The overall CPR quality exhibited medians of 75% for the Std-CPR and 82% for the SSC-CPR (p = 0.06). Conclusions: Performing CPR on a newborn over the mother’s body during SSC is feasible and does not compromise the quality of resuscitation maneuvers. This approach may offer advantages in preserving maternal–newborn bonding and optimizing newborn outcomes. Further studies are needed to address the limitations of this research, including the use of simulations that may not fully replicate real-life conditions, the lack of analysis of different types of labor, and the unpredictability of the maternal response during resuscitation. Full article

Introduction: Cardiopulmonary resuscitation with mechanical devices (MCPR) was developed to provide high-quality cardiopulmonary resuscitation (CPR) for patients with cardiac arrest. However, the effect of this procedure on treatment outcomes remains controversial. Nevertheless, during the coronavirus disease-19 (COVID-19) pandemic, in-hospital MCPR gained attention, owing to its advantages such as saving medical staff and preventing infection. This study compared the treatment outcomes of in-hospital MCPR and manual CPR for out-of-hospital cardiac arrest (OHCA) patients during the COVID-19 pandemic. Materials and Methods: This retrospective nationwide population-based study was conducted in South Korea. Data were collected from the Out-of-Hospital Cardiac Arrest surveillance database managed by the Korea Disease Control and Prevention Agency. We included adult OHCA patients transported by emergency medical services from 2016 to 2021. The study compared outcomes during the COVID-19 pandemic years (2020–2021) with the preceding non-pandemic years (2018–2019). The primary outcome was survival to hospital discharge, and the secondary outcomes were good neurological outcome and sustained return of spontaneous circulation (ROSC). Results: The entire study included 72,050 patients with OHCA and, in the multivariable analyses, MCPR was associated with lower survival rates compared to manual CPR (AOR 0.63; 95% CI 0.51–0.77; p < 0.001). Interestingly, during the COVID-19 pandemic, while MCPR use increased, the survival rate did not differ significantly between the MCPR and manual-CPR groups. Conclusion: Our study findings suggest that while MCPR may offer potential benefits, such as decreased infection risk for healthcare workers, it did not demonstrate superior outcomes compared to manual CPR in our study population. Full article

Background: Cardiac arrest is a critical condition affecting approximately 1 in every 1000 people in Europe. Feedback devices have been developed to enhance the quality of chest compressions during CPR, but their clinical impact remains uncertain. This study aims to evaluate the effect of feedback devices on key clinical outcomes in adult patients experiencing both out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). The primary objective is to assess their impact on the return of spontaneous circulation (ROSC); secondary objectives include the evaluation of neurological status and survival to discharge. Methods: A systematic review was conducted following PRISMA guidelines, utilizing databases including PubMed, Scopus, Web of Science, and Embase. Studies published between 2000 and 2023 comparing CPR with and without the use of feedback devices were included. A fixed-effects network meta-analysis was performed for ROSC and survival, while a frequentist meta-analysis was conducted for neurological outcomes. Results: Twelve relevant studies met the inclusion criteria. The meta-analysis results showed that the use of audiovisual feedback devices significantly increases the likelihood of ROSC (OR 1.26, 95% CI 1.13–1.41, p < 0.0001) and survival (OR 1.52, 95% CI 1.27–1.81, p < 0.0001) compared to CPR without feedback. However, the effect of metronomes did not reach statistical significance. Conclusions: Feedback devices, particularly audiovisual ones, are associated with improved clinical outcomes in cardiac arrest patients. Their use should be encouraged in both training settings and real-life emergency scenarios to enhance survival rates and ROSC. However, further studies are needed to confirm long-term impacts and to explore the potential benefits of metronomes. Full article

Background. The quality of cardiopulmonary resuscitation (CPR) is pivotal in improving the outcome of cardiac arrest. Nevertheless, there is evidence that even professional rescuers may deliver ineffective chest compressions (CCs). We sought to evaluate the impact of a CPR feedback device on the quality of CC performed by a supposedly highly trained and skilled population of attendees to the national annual congress of the Italian Resuscitation Council. Methods. A total of 202 congress attendees were enrolled to perform 2 min CC without feedback, followed by a 5 min rest and another 2 min interval of CC with feedback. Moreover, participants were randomly assigned to two study groups: “feedback later”, in which the first 2 min CCs were delivered without the feedback, and “feedback first”, in which the first 2 min CCs were aided by feedback. CPR quality has been analyzed in terms of the percentage of CC with adequate depth (CC, %), complete chest release (CR, %), and the CC rate (CC/min). Results. Approximately 60% of correct CCs were performed without feedback, which significantly increased to 79% with the use of feedback. In the “feedback later” group, the percentage of correctly performed CC and CR significantly increased during the second 2 min interval of CC with feedback (median value 51% vs. 86%, p < 0.0001 and 71% vs. 84%, p = 0.025, respectively). In the “feedback first” group, the percentage of correct CC remained stable during the two CC intervals (71% vs. 80%, p = 0.06), while CR was better without the help of the feedback (70% vs. 93%, p < 0.0001). CC/min was in the recommended range (100–120/min) in all the CC events. Conclusions. In this population of expected highly skilled CPR providers, the overall quality was inconsistent and, in many cases, did not reach guidelines recommendations. The use of a feedback device significantly improved the quality of CC. When the feedback device was used in the first CC attempt, it had a learning effect that was reflected in maintaining quality during the second CC series. Full article