Quality of Chest Compressions Differs over Time between Advanced and Basic Life Support

Purpose: According to guideline recommendations, chest compressions (CC) during cardiopulmonary resuscitation (CPR) should be performed at a rate of 100 - 120 per minute, with a CC fraction (CCF) of ≥80%. The aim of this work is to explore whether CC quality differs between advanced life support (ALS) and basic life support (BLS) performed by two rescuers. Method: Cardiopulmonary resuscitation was performed by two ambulance personnel in ten ALS and ten BLS manikin scenarios. Data from these scenarios were then compared with data on ten ALS cases from the clinical setting, all with non-shockable rhythms. Data from the first two 5-minute periods of CC were evaluated from impedance data (LIFEPAK 12 defibrillator monitors) using a modified Laerdal Skillmaster manikin. Quality parameters compared were: number of CC pauses (CCPs), total time of CC (%), number of CC given and CC rate/min. Results: During the first 5 minutes, the BLS manikin scenarios had the highest number of CCPs, 15 (14 - 16), compared with the ALS manikin scenario, 14 (13 - 15), and the clinical ALS cases, 12 (10 - 15). The BLS scenario also had the highest CCFs, 81% (77% - 85%), and number of CC, 450 (435 - 495), compared with the ALS manikin scenario, 75% (64% - 81%) and 400 (365 - 444) respectively, and the clinical ALS cases, 63% (50% - 74%) and 408 (306 - 489). The median rate of CC/min in the BLS scenario was 115 (110 - 120) compared with the ALS manikin scenario, 110 (106 - 115), and the clinical ALS cases, 130 (118 - 146). During the second 5-minute period, the BLS scenario had the highest number of CCPs, 16 (15 - 17), compared with 15 (14 - 16) for the ALS manikin scenario and 11 (11 - 12) for the clinical ALS cases. The CCF in the BLS setting was 79% (75% - 83%), and the number of CC 455 (430 - 480), compared with the ALS manikin scenario, 79% (74% - 84%) and 435 (395 - 480) respectively, and the clinical ALS cases, 71% (57% - 77%) and 388 (321 - 469) respectively. The median CC rate was 118 (113 - 124) for BLS, 111 (105 - 120) for ALS manikins and 123 (103 - 128) CC/min for clinical ALS cases. Conclusion: None of the groups being studied could deliver CC at a rate of 100 - 120 CC/min or a CCF of ≥80% over the whole 10-minute period in any of the resuscitation scenarios analyzed. However, BLS had the best compliance with CC quality recommendations according to the 2010 guidelines.

Modified Advanced Life Support in Obstetrics course: Feasibility, trainee satisfaction, and sustainability potential

Objective:The main objective of this initiative was to present evaluation results from an inno-vative adaptation of the Advanced Life Support in Obstetrics(ALSO)training course.We modified the traditional ALSO curriculum in our institution by adding hands-on training in laceration repairs and simulation scenarios on acute maternity care.Methods:The modified ALSO provider course was designed to enhance cognitive and proce-dural skills of health care professionals in managing obstetric emergencies.Forty-nine participants attended this course and completed a posttraining survey.Descriptive statistics were used to de-scribe the participant-reported assessment scores for the ALSO course on three domains(subject knowledge,organization and clarity,and teaching effectiveness)for each of 12 course topics.Results:Evaluation of the results showed a high rate of trainee satisfaction as evidenced by the mean assessment scores across all topics ranging from 4.80 to 4.98(out of 5.00).All trainees said they would refer others to the course.Our modified ALSO course effectively addressed the important needs of primary care physicians involved in maternity care,especially in underserved communities where specialized obstetric care is not readily available.Both simulation scenarios and workshops using simulated human tissue provide a better foundation before formal training.Conclusion:Given the changing legal and regulatory climate,we expect that learning to treat complex obstetric situations on the job will become increasingly risky.With this in mind,both simulation scenarios and workshops using simulated human tissue will provide a better foundation before formal training.

Is current training in basic and advanced cardiac life support(BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala

BACKGROUND:Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support(BLS/ACLS) guidelines to revive unresponsive patients.METHODS:Across-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire.Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.RESULTS:Among 461 healthcare professionals,141(30.6%) were practicing physicians,268(58.1%) were nurses and 52(11.3%) supporting staff.The maximum achievable score was 20(BLS15/ACLS 5).The mean score amongst all healthcare professionals was 8.9±4.7.The mean score among physicians,nurses and support staff were 8.6±3.4,9±3.6 and 9±3.3 respectively.The majority of healthcare professionals scored <50%(237,51.4%);204(44.3%) scored 51%-80%and 20(4.34%)scored >80%.Mean scores decreased with age,male sex and across occupation.Nurses who underwent BLS/ACLS training previously had significantly higher mean scores(10.2±3.4) than untrained(8.2±3.6,P=0.001).Physicians with <5 years experience(P=0.002) and nurses in the private sector(P=0.003)had significantly higher scores.One hundred and sixty three(35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt,chin lift and jaw thrust.Only 54(11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79(17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms.The majority of healthcare professionals(356,77.2%) suggested that BLS/ACLS be included in academic curriculum.CONCLUSION:Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals,especially physicians,illuminate lacunae in existing training systems and merit urgent redressal.

Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report

BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury,although elbow dislocation or fracture of the ulna and radius may occur separately.CASE SUMMARY We report the case of a 37-year-old woman with open(IIIA)fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony.After providing advanced trauma life support,damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room.Subsequently,one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling.The patient achieved good outcome at the 7 mo follow-up.CONCLUSION One-or two-stage treatment must be performed according to the type of injury;we efficiently used the“damage control principle.”

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）.