Is There an Improvement in Patient Survival/Code Blue Activation after Training Based on Simulation (Basic Life Support—BLS) Based Practice of Cardiopulmonary Resuscitation?

Background and Aim: The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre- and post-simulation-based BLS training (BLS) and the outcome was measured on the basis of patient survival after the cardiac arrest. Study Design: This pre- and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. Results: 296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff—providers) were graded for the response by pre- and post-training testing. In the course of pre-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC (p < 0.05). Conclusion: A simulation-based CPR and BLS training curriculum greatly improves patient outcome by reducing mortality and morbidity with improved subjectivity, self-efficiency along with the objective assessment of the performance scores during acute cardiac arrest in Emergency Cardiovascular Care (ECC).

Evaluation of Prognosis of Brain Function with Early Transcranial Color Doppler Ultrasound in Patients after Cardiopulmonary Resuscitation

Objective: To evaluate the clinical value of transcranial color Doppler ultrasound (TCCD) in assessing cerebral function after cardiopulmonary resuscitation (CPR). Methods: A prospective study was conducted in 52 patients with cardiac arrest treated by CPR from January 2018 to January 2020, and its clinical data were analyzed. According to classification of cerebral performance category (CPC), 31 cases (CPC grade 1 - 2) were selected in the good prognosis group and 21 cases (CPC grade 3 - 5) in the poor prognosis group. The cerebral blood flow was measured by transcranial Doppler ultrasound (TCCD) 24 h after CPR, and the differences were compared between the two groups in stroke index, diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function. Results: The data showed that the pulsatility index of middle cerebral artery of the poor prognosis group decreased within 24 h;the difference between the two groups was statistically significant (p < 0.05);the Vd, Vs, Vm increased in the good prognosis group;the difference between the two groups was statistically significant (p < 0.05). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function, and the results showed that the area under the curve and the optimal critical value of cerebral blood flow were 0.731 and 5.69. The sensitivity and specificity were 67.3% and 79.1% respectively. Conclusion: The cerebral blood flow increase in the early stage of successful CPR is positively correlated with the prognosis of cerebral functional resuscitation. Monitoring intracranial blood flow after CPR by TCCD has clinical value to evaluate prognosis of brain function.

Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation

Objective To evaluate the efficacy of the continuation of eardiopulmonary resuscitation （CPR） following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services （EMS） CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients （15%） accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluated in the future when prehospital information can be combined with in-hospital information （J Geriatr Cardio12009; 6：142-146）.

Predicting various outcomes of post-resuscitation comatose survivors： PRCSs Prognostication Score

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation （CPR） and validate its performance. Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation. A value was assigned to these variables. We used these variables in combination with APACHE II score to devise a multifactorial prediction score system, which we called PRCSs Prognostication Score （PRCSs-PS）. Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS. Score of patients with different outcomes was compared. The area under the receiver- operating characteristic （ROC） curve was determined to evaluate performance of this tool to identify patients with a poor outcome （CPC4 and 5） and other outcomes （CPC1, 2, and 3）. Results There were differences of PRCSs-PS score among multiple groups with five different outcomes （CPC 1-5）（F=65.91, P=0.000）. Pairwise groups with different CPC were compared： no significant difference was noted between CPC1 and CPC2 （12.41±6.49 vs 17.38±6.91,P=0.092）, but difference between other pairwise CPC groups was statistically significant （CPC2 vs CPC3：17.38±6.91 vs 24.50±5.80, P=0.041, CPC3 vs CPC4：24.50±5.80 vs 32.29±5.24, P=0.006）. The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows： it had 100% sensitivity, 78.6% specificity, and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity, 100% specificity and 176.4 diagnostic index at the score cut-off32.5. Score 23 and 33 were two key cut-offpoints. The area under the ROC curve was 0.968, showing excellent discrimination. Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

Basic life support:knowledge and attitude of medical/paramedical professionals

BACKGROUND:Basic life support(BLS),a key component of the chain of survival decreases the arrest-cardiopulmonary resuscitation interval and increases the rate of hospital discharge.The study aimed to explore the knowledge of and attitude towards basic life support(BLS)among medical/paramedical professionals.METHODS:An observational study was conducted by assessing response to self prepared questionnaire consisting of the demographic information of the medical/paramedical staff,their personnel experience/attitude and knowledge of BLS based on the 2005 BLS Guidelines of European Resuscitation Council.RESULTS:After excluding incomplete questionnaires,the data from 121 responders(27 clinical faculty members,21 dental and basic sciences faculty members,29 house officers and 44 nurses and health assistants)were analyzed.Only 9(7.4%)of the 121 responders answered≥11,53(43%)answered 7-10,and 58(48%)answered<7 of 15 questions correctly.The clinical faculty members,house officers and nurses/HA had a mean score of 7.4±3.15,7.37±2.02 and 6.63±2.16 respectively,while dental/basic sciences faculty members attained a least mean score of 4.52±2.13(P<0.001).Those who had received cardiopulmonary resuscitation(CPR)training within 5 years obtained a highest mean score of 8.62±2.49,whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54±2.38 and 6.1±2.29 respectively(P=0.001).Those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all(P<0.001).CONCLUSIONS:The average health personnel in our hospital lack adequate knowledge in CPR/BLS.Training and experience can enhance knowledge of CPR of these personnel.Thus standard of CPR/BLS training and assessment are recommended at our hospital.

Training of Laic Blind Subjects to Basic Life Support Manoeuvres

Heart attack is an extremely urgent medical condition which may occur at any time and can affect anybody and means the failure of the pump function of the heart and it represents the condition which brings to death. The aim of this study is the training, which is the acquisition of knowledge, abilities and skills as a result of education and practice in a certain discipline and this project has been created to make as accessible to all as possible the information about the identification and treatment of heart attack. However, the key objective has been involving only laic blind subjects in the trial and theoretical-practical course to support vital functions （BLS （basic life support））, to demonstrate that in a state of emergency, like a heart attack, even a subject affected by visual impairment, if properly trained, can be very helpful and can contribute to save a life. Fifteen partially sighted and sightless executors have participated in this study. In order to evaluate learning objectives of the course, participants have completed a pre-course test to examine these areas： cognitive and emotional, motivational, theoretical-practical; while, at the end of the course, participants have completed a comment card about the course. At the end of this study it can be seen that blind subjects do not present any type of limitation in the learning and in the execution of BLS manoeuvres after an appropriate training.