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@#Introduction: Malaysia has not legalized CPR teaching in the national curriculum, leaving it to school principals to implement the teaching of CPR who may have limited knowledge. This study aims to investigate Malaysian secondary school principals’ level of readiness, defined as knowledge, attitude, willingness to teach CPR, and barriers to implementation. Methods: Malaysian secondary school principals were invited to complete a survey that consisted of five parts: (1) demographics, (2) CPR knowledge, (3) attitude towards CPR, (4) willingness to teach CPR, and (5) barriers to implementing CPR teaching. Results: A total of 54 secondary school principals responded to the survey. Three (5.6%) principals passed the CPR test. More than 80% agreed CPR course is important for students, mandatory to be taken before graduation and best taught by certified teachers. Principals are willing to qualify themselves and teachers with CPR certification and to provide funding to support and hire an outsider to teach CPR courses. Funding, teachers’ readiness for skills and knowledge proficiency, and curriculum burden are perceived as potential barriers to successful CPR teaching. One-way MANOVA analysis showed that gender (p = .257), age (p = .108), qualifications (p = .321), teaching experience (p = .194), and administrative experience (p = .193) did not have a significant effect on the combined dependent variables. Conclusion: Malaysian secondary school principals are aware of the importance of CPR and were willing to acquire the knowledge, skills, funds, equipment, and support in ensuring its implementation in the national curriculum.
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Women who suffer out-of-hospital cardiac arrest receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) less frequently than that of men. Understanding the public perception on the necessity of the occurrence of life-saving disparities for fair intervention application to individuals with injuries and sickness is needed. The participants were undergraduate students of the university. Anxiety and irritability towards bystander CPR and AED operations were investigated. The participants of the analysis were 368 individuals (153 men and 215 women), of which 80.4% of men and 95.8% of women had anxiety about life-saving procedures. Regarding AED operation, 90 (58.8%) men and 74 (34.4%) women hesitated on removing clothing from a woman with injury or sickness. The reasons on women with injury and illness were less likely to be suitable with AEDs involved anxiety about life-saving procedures, litigation issues, and posting and spreading on social networking sites (SNS). Particularly, if men intervened with women with wounds, the main limitations were the risk of the act developing into a lawsuit and gaze of others, namely SNS. Bystander anxiety towards life-saving procedures was found to be strongly expressed by women. It also became evident that early recognition of cardiac arrest was not performed for patients with injuries 20–30% of the time. Training specifically for women with wounds and sickness may reduce sex differences in bystander CPR and AED application.
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Early chest compressions and rapid defibrillation are important components of cardiopulmonary resuscitation (CPR). American heart association (AHA) recommends two breaths to be delivered for every 30 compressions for an adult cardiac arrest victim. Patient with an advanced airway like endotracheal tube (ETT) should be given one breath every 6 s without interruptions in chest compression (10 breaths per minute). All of the modern mechanical ventilators have option to generate spontaneous breaths by the patient if the patient has spontaneous respiratory efforts. During CPR, the mechanical ventilator is fallaciously sensing the chest compressions as patient's spontaneous trigger and thereby it delivers higher respiratory rates. Avoiding excessive ventilation is one of the components of high quality CPR as excessive ventilation decreases venous return thereby decreasing the cardiac output and also it affects intra-thoracic pressure thereby adversely affects intra-arterial pressure. As modern ventilators have trigger for spontaneous breaths and they will be erroneously triggered by chest compressions, it would be prudent to use volume marked resuscitation bags or manual breathing devices (manual self-inflating resuscitation bag, Bain's circuit) for delivering breaths which can be synchronised with compression phase of CPR at RR of 10 breaths per min with advanced airway in place. If any patient who is on mechanical ventilation develops cardiac arrest, patient should be disconnected from the mechanical ventilator and should be ventilated manually. Manual ventilation with aforementioned breathing devices should be used in a patient without and with advanced airway devices during CPR.
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Sudden cardiac arrest (SCA) remains a major healthcare issue worldwide with gloomy outcomes due to poor perfusion of cardiopulmonary resuscitation (CPR), deemed unsuitable for hemostatic conditions, cardiotorsal anatomy, electrophysiology, and thoracic biomechanics. Alternatively, we propose a new management, implementing rational exploitation of the stagnant blood masses: manually with a novel technique of cardiac massage and mechanically with a circulatory flow restoration (CFR) device. Methods: Simulated chest compressions were performed through the 5th intercostal space in professional Lifeguards volunteers, placed in the left lateral decubitus position with raised legs and abdominal compression. Results: Bypassing the sternal barrier, refilling the heart, and then compressing the chest with a recoil-rebound maneuver (3R / CPR) can significantly promote return of spontaneous circulation (ROSC). The effectiveness of the CFR device versus CPR has previously been demonstrated in the literature. Conclusion: Unlike current CPR, the 3R/CPR adapts human morphology and provides adequate myocardial perfusion promoting ROSC safely, under all circumstances. Preclinical computational models can confirm the effectiveness of the technique.
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Background: Basic life support (BLS) is a lifesaving skill which every health-care personnel must know. It has been added to the curriculum but still studies have shown poor knowledge and skill among them in India. Aims and Objectives: The aim of our study was to assess attitude and knowledge of BLS among healthcare personnel in a tertiary care center of Sikkim and to recommend training of BLS according to the finding of our study. Materials and Methods: A questionnaire based cross-sectional study was done among junior doctors, physiotherapists, and nursing staffs, who were willing to participate. The questionnaire collected data under the heading of demographics, attitude, awareness, and knowledge about various domains of BLS. Analysis was done with standard statistical software. Results: Among 208 completed surveys, 24 (11.5%) were males and 184 (88.5%) were females, majority of them (76.4%) were nursing staff and belonged to 20�-year age group (76%). Mean score of the participants were 13.43 � 3.725 with a range from 2 to 21. The necessity of BLS training and the requirement of mandatory renewal was strongly agreed by 77.4% and 33.2% participants respectively. Conclusion: We conclude that they all need the trainings at frequent interval to know about the importance of BLS, to gain confidence and to improve their skill which will help them in timely saving of many lives in as well as outside the hospital. This can be achieved if institutes help in conducting the BLS session regularly despite being already in curriculum.
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Introduction: Cardiopulmonary resuscitation (CPR) is a life saving procedure and adequate knowledge and skills related to CPR are essential for all medical students. This study was undertaken to compare knowledge and practice related to updated CPR guidelines by American Heart Association (AHA) 2020 between junior residents and interns. Methods:This is a questionnaire-based study prepared on Google form consisting of 22 questions on CPR. Total of 124 participants included 41 junior residents and 83 interns. They were advised to read questions carefully and allowed to tick one best response among the options. Results: An average overall correct response from both the group was 14.48 (65.81 %). Among theory knowledge-based questions junior residents had an average of 8.707 correct answers out of 11 (79.15%) which is more correct answers than interns who have average 5.90 correct (53.63%). Similarly, in terms of practical knowledge, junior residents had an average score 9.682 out of 11 (88.026%) compared to interns who had an average of 6.518 out of 11 (59.27%). Conclusion: The study showed poor knowledge about CPR among the interns. More practical based teaching should be employed in MBBS curriculum. Periodical reinforcement and refresher courses should be part of curriculum.
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Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.
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Objective:To evaluate the outcome of the patients receiving dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) delivered by first-responders who witnessed the out-of-hospital cardiac arrest (OHCA) before the Emergency Medical Service (EMS) arrived.Methods:We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Meta-analysis was performed on three outcome indicators (recovery of spontaneous circulation survival to hospital discharge and survival with favourable neurologic outcome) using the Revman5.3 software.Results:A total of 21 studies with 349 822 patients were selected for the meta-analysis, including 182 125 patients in the DA-CPR group and 167 697 in the CPR-only group. The meta-analysis showed no significant difference between the DA-CPR and CPR-only groups in ROSC [ RR=1.10, 95% confidence interval ( CI): 0.94-1.29, P=0.24], survival to hospital discharge ( RR=1.10, 95% CI: 0.90-1.34, P=0.34) and survival with favourable neurologic outcome ( RR=1.01, 95% CI: 0.79-1.28, P=0.97) of the patients in America, Japan and Korea. However, there was a significant difference between the DA-CPR and the CPR-only groups in ROSC ( RR=2.61, 95% CI:1.53-4.46, P=0.0005), survival to hospital discharge( RR=6.08, 95% CI: 1.84-20.04, P=0.003), and survival with favourable neurologic outcome( RR=9.76, 95% CI: 1.87-51.02, P=0.007) of the patients in China. Conclusions:The overall effect of DA-CPR is significantly different for each country. In detail, DA-CPR offers a survival advantage (Return of spontaneous circulation, survival to hospital discharge and survival with favourable neurologic outcome) over CPR alone in China but no advantage in developed countries.
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Objective:Pulse oximetry plethysmographic (POP) waveform to indicate the patient's perfusion status and the quality of resuscitation has been affirmed. The POP waveform is obtained by a non-invasive monitoring method, and its clinical feasibility during CPR is better than that of invasive monitoring technologies. This study aimed to analyze the three parameters derived from POP waveform: CPR quality index (CQI), perfusion index (PI), and chest compression fraction (CCF) in evaluating the CPR quality and ROSC possibility.Methods:A prospective descriptive study was conducted on 74 CPR patients who were divided into the ROSC group and non-ROSC group according to their resuscitation results. The clinical data were extracted from patient monitor, the distribution and changes of the three parameters during CPR were collected, and their value of evaluating resuscitation outcome were analyzed.Results:At the end stage of resuscitation, there were statistically significant differences in the three parameters between the two groups ( P<0.05). In addition, CQI was significantly more capable in evaluating the possibility of ROSC than PI and CCF ( P<0.05). Conclusions:CQI, PI and CCF derived from POP waveform can all be applied to evaluate CPR quality and ROSC possibility. CQI has higher prognosis value than PI and CCF.
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Introduction: Statistics show nowadays, bystanders provided Cardiopulmonary Resuscitation (CPR) in 40-46% of all out-of-the-hospital cardiac arrests. Strategies must focus on specialized training for non-medical personnel. Engaging new generations in self-care depends on the development of new approaches to address the issue. The objective of this study was to assess the efficacy of an innovative training in CPR through the perception of the participants. Material and methods: This study considered a quantitative approach with a descriptive and correlational design. This study had a convenience sample of 103 participants from undergraduate programs in different disciplines: Engineering, Health, Law, and Design with participated voluntarily in the innovate training. To understand the efficacy of the innovative training data was collected of the participants through a self-assessment rubric. While participants were taken part in the training, an expert assessor was observing the performance and scored the procedure using a similar rubric. Both rubrics use a 5-point Likert scale to assess the level of agreement with each sentence. Results: Self-assessment results show that students excel on identifying if a patient has a pulse (mean=4.47) and if a patient is breathing (mean=4.52). The results of the expert assessment indicate a higher level of performance in hand positioning (mean=4.75) and compression-ventilation coordination (mean=4.77).Discussion: These results are encouraging as participants gained confidence on basic procedures, the main challenges are still on skills that rely deeply on practice. Therefore, this training might need to be offered periodically, as any certification offered for health professionals. This study is a first attempt to design an innovative short term and effective training that universities can replicate to prepare their students for these life-saving skills.
Introducción:Las estadísticas muestran que hoy en día los transeúntes realizan la reanimación cardiopulmonar (RCP) en el 40-46% de las paradas cardíacas extrahospitalarias. Las estrategias deben centrarse en la formación especializada del personal no médico, por lo que es importante desarrollar; nuevos enfoques para abordar el tema y comprometer a las generaciones más jóvenes en el autocuidado. El objetivo de este estudio fue evaluar la eficacia de un entrenamiento innovador en RCP a través de la percepción de los participantes.Ma-terial y métodos: Se utilizó un diseño cuantitativo para correlacionar ambas medidas de rendimiento. Este estudio consideró un enfoque cuantitativo con un diseño descriptivo y correlacional. Este estudio tuvo una muestra de conveniencia de 103 participantes de programas de pregrado en diferentes disciplinas: Ingeniería, Salud, Derecho y Diseño con participación voluntaria en el entrenamiento innovador. Para entender la eficacia de la formación innovadora se recogieron datos de los participantes a través de una rúbrica de autoevaluación. Mien-tras los participantes participaban en la formación, un evaluador experto observaba la actuación y puntuaba el procedimiento utilizando una rúbrica similar. Ambas rúbricas utilizan una escala Likert de 5 puntos para evaluar el nivel de acuerdo con cada frase.Resultados: Los resultados de la autoevaluación muestran que los estudiantes destacan en la identificación de si un paciente tiene pulso (media=4,47) y si un paciente respira (media=4,52). Los resultados de la evaluación de expertos indican un mayor nivel de rendimiento en la colocación de las manos (media=4,75) y en la coordinación compresión-ventilación (media=4,77). Discusión: Estos resultados son alentadores, ya que los participantes ganaron confianza en los procedimientos básicos; los principales retos siguen siendo las habilidades que dependen en gran medida de la práctica. Por lo tanto, es posible que esta formación deba ofrecerse periódicamente, como cualquier certificación ISSN: 0719-1855 © Dirección de Extensión y Educación Continua, Escuela de Medicina, Pontificia Universidad Católica de Chile. http://arsmedica.cl26ARS MEDICA Revista de Ciencias Médicas Volumen 46 número 3 año 2021Segura et al.ofrecida a los profesionales de la salud. Este estudio es un primer intento de diseñar una formación innovadora, eficaz y de corta duración, que las universidades pueden replicar para preparar a sus estudiantes en estas habilidades que salvan vidas.
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Background:Cardiopulmonary resuscitation (CPR) reduces cardiac arrests and related deaths when patients receive CPR promptly from adequately trained and specialized healthcare professionals. Quality CPR consists of providing an appropriate frequency and depth of compressions, minimised interruptions and appropriate volume of ventilation. The objective of the study was to determine the current level of knowledge /awareness of Cardiopulmonary Resuscitation (CPR) among Final Year B. Physiotherapy students. Material And Methods:This cross-sectional study involved final year B. Physiotherapy students from different colleges of Ahmedabad. A Questionnaire containing 14 Questions was given to the students and were ask to tick the most appropriate answer.Result:The average score is 44.53% (N=200). While only 31.5% of them were completely aware of the universal compression rate, 62.5% were aware of the compression depth in adults whereas only 19% were aware of the compression depth in infants.Conclusion:This questionnaire survey demonstrated that CPR skills in physiotherapy students were insufficient, which could be improved by well-designed certified training programs.
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Triterpenoids are a class of natural products of great commercial value that are widely used in pharmaceutical, health care and cosmetic industries. The biosynthesis of triterpenoids relies on the efficient synthesis of squalene epoxide, which is synthesized from the NADPH dependent oxidation of squalene catalyzed by squalene epoxidase. We screened squalene epoxidases derived from different species, and found the truncated squalene epoxidase from Rattus norvegicus (RnSETC) showed the highest activity in engineered Escherichia coli. Further examination of the effect of endogenous cytochrome P450 reductase like (CPRL) proteins showed that overexpression of NADH: quinone oxidoreductase (WrbA) under Lac promoter in a medium-copy number plasmid increased the production of squalene epoxide by nearly 2.5 folds. These results demonstrated that the constructed pathway led to the production of squalene epoxide, an important precursor for the biosynthesis of triterpenoids.
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Animals , Rats , Escherichia coli/genetics , NADPH-Ferrihemoprotein Reductase , Protein Engineering , Repressor Proteins , Squalene , Squalene Monooxygenase/geneticsABSTRACT
@#Introduction: Vaccination is a biological process that improves immunity level of an individual towards certain diseases. Vaccination is generally given to all newborn and kids. Most countries oblige their citizens to be vaccinated as early as new-born age. The aim of this research is to study the perception on vaccination intake and the associated factors that lead to its refusal among parents in east coast and west coast peninsular Malaysia. Methods: Primary data were collected using self-administered questionnaire and were distributed to assess the study objectives. Total 240 questionnaires were distributed equally in west coast and east coast study area. Questionnaire consists of demographic data, perception aspects and factors that may lead to the negative perceptions. Results: There is significant association between perception and religion, education level and side effect factor in east coast with majority of the respondents are Muslims (40.83%) while there is no significant association between education level and side effect factor (p>0.1) in west coast with majority of respondents are Muslims (51.67%) too. This study found that perception regarding vaccination is influenced by the religion restrictions in east coast of peninsular Malaysia and not in west coast region. The other factors associated with vaccination refusal varies according to education level, and regional basis. Conclusion: Most of the respondents who have negative perception regarding vaccination are from East Coast region as they are more prone into Islamic teachings. All the possible factors of vaccination refusal are accepted by the respondents but varies in its prevalence as the leading factor determined that caused the vaccination refusal are religion restriction and the least percentage for the factor is time restriction.
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@#Introduction: There is global support for the teaching of cardiopulmonary resuscitation (CPR) in schools, and teachers are expected to play a leading role in a medical emergency. For effective resuscitation, retention of CPR knowledge after training is paramount. This study aimed at assessing the retention of CPR knowledge among student teachers at pre-, post-immediate, 8th-, and 14th-week post-training. Method: A quasi-experimental study using non-probability convenience sampling was conducted to select 41 respondents from the Department of Physical and Health Education, Faculty of Education (UiTM). A validated American Heart Association's 2015 Basic Life Support (BLS) multiple-choice questions (MCQ) were utilised to measure the retention of knowledge among the participants. Results: This study demonstrated a significant lack of CPR knowledge during pre-test with the mean scores of M=8.02 despite half of the participants had prior knowledge in CPR. Nevertheless, the paired t-test revealed a significant improvement in the post-scores following the intervention at M=16.20, t(40) = -18.56, p < 0.001, and d=3.91. The one-way RM-ANOVA results showed a decline in the retention rate at the 8th week (M=13.06; p < 0.001) and an improvement at the 14th weeks (M= 5.74; p < 0.001). Conclusion: The knowledge of CPR among the student teachers following the intervention program was appropriate, but the deterioration of retention suggested that all student teachers should undergo comprehensive routine CPR courses to avoid the immediate loss of CPR knowledge and skills. The governing bodies in Malaysia should implement CPR training as part of the curriculum for teachers.
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INTRODUCTION@#In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction 'push 100 times a minute 5 cm deep'. As part of quality improvement, the instruction was simplified to 'push hard and fast'.@*METHODS@#We analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ('push 100 times a minute 5 cm deep') and August to September ('push hard and fast'). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231).@*RESULTS@#A total of 506 cases were included: 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001).@*CONCLUSION@#Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.
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Oxygen is an essential constituent for plants and animals. Before birth the foetus receives oxygen from placenta. Dysfunction of heart is one of the leading causes of death among people residing in developed countries. For most of the patients with cardiac arrest, advanced emergency care support is not available in developing countries; whereas, in developed countries, professionals will arrive immediate at the place within 10 min. The objective of the study was to evaluate the existing knowledge and skills related to CPR in secondary school teachers. We also investigated the effectiveness of simulation-based teaching on CPR among secondary school children. MethodsWe performed one group pre- and post-test study on selected secondary school teachers with a samples size of 60 and used 20-item questionnaire with skill checklist. ResultsThe mean value of pre-test and post-test results among secondary school teachers’ in level of knowledge was 6.05 and 10.33, standard deviation was 2.79 and 1.38, The mean difference values were 4.28 ± 3.1. The mean value of pre-test and post-test of secondary school teacher in the level of practices was 2.85 and 3.91, standard deviation was 0.54 and 0.90, The mean difference was 1.06 ± 1.08. ConclusionsSimulation teaching of CPR in secondary school teachers was effective.
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@#Introduction: Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers. Methods: This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models. Results: The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44). Conclusion: The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR
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The SARS-CoV-2 pandemic that we are currently experiencing has produced new clinical scenarios, within these, prone ventilation is one of the most frequent, especially in critically ill patients, exposing us to having to perform CPR on a patient who is in a prone position. The first suggestion of a prone CPR technique was made by McNeil in 1989. To date, there have been several cases of prone CPR described, most using the technique described by McNeil or small variations of these, achieving success in resuscitation. The technique consists of positioning oneself over the patient who is in a prone position, sitting on his buttocks and resting our hands on the back of the chest and then compressing the chest using a forward swinging motion at an average speed of 40 compressions per minute, with the aim of allowing passive re-expansion of the chest. At the same time, to maintain a patent airway, either victim's arms should be positioned below their forehead so that the bridge of the nose rests on the flexion crease of the elbow, with the nose pointing directly downward. For the defibrillation in prone, two possible alternative positions of the patches/ paddles have been described that have been used successfully: position one of the patches under the patient in prone, in relation to the area of greatest ventricular mass, and the other in his back, specifically on the right shoulder blade. The second one used two patches positioned on the patient's back, one in the lower left region just posterior to the mid-axillary line and the other just below the right shoulder blade. It has been shown that the compressions performed in the prone would be as or more effective than those performed in the supine position with the standard technique, the prone technique also presenting the benefit of producing passive ventilation simultaneously with the same compression maneuver. The situation we are living in deserves to take all the tools we have, so this technique presents a viable alternative to perform in clinical practice, however, more studies are needed in this regard to establish if there is a real benefit from this technique regarding the classical technique. Expert recommendations for CPR have emerged in the context of the COVID-19 patient in which there is consensus that it is reasonable to initiate resuscitation in the prone position in COVID-19 patients who are intubated and ventilated in this same position.
La pandemia de SARS-CoV-2 que vivimos actualmente ha producido nuevos escenarios clínicos, dentro de estos la ventilación en prono es uno de los más frecuentes, sobre todo en pacientes críticos, exponiéndonos a tener que realizar una RCP a un paciente que se encuentra en prono. La primera sugerencia de una técnica de RCP en prono fue realizada por McNeil en 1989. A la fecha existen diversos casos descritos de RCP en prono, la mayoría utilizando la técnica descrita por McNeil o pequeñas variaciones de estas, logrando éxito en la reanimación. La técnica consiste en posicionarse sobre el paciente que se encuentra en prono, sentándose el reanimador sobre las nalgas de este y apoyando las manos sobre la parte posterior del tórax para luego comprimir el tórax mediante un movimiento de balanceo hacia adelante a una velocidad promedio de 40 compresiones por minuto, con el objetivo de permitir la reexpansión pasiva del tórax. A la vez, para mantener la vía aérea permeable se debe posicionar cualquiera de los brazos de la víctima por debajo de su frente de manera que el puente de la nariz descansara sobre el pliegue de flexión del codo con la nariz apuntando directamente hacia abajo. Para la desfibrilación en prono se han descrito dos posibles posiciones alternativas de los parches/ paletas que han sido utilizadas de forma exitosa: posicionar uno de los parches bajo el paciente en prono, en relación a la zona de mayor masa ventricular y el otro en la espalda de este, específicamente sobre la escápula derecha; utilizar dos parches posicionados en la espalda del paciente, uno en la región izquierda baja justo posterior a la línea axilar media y el otro justo bajo la escápula derecha. Se ha evidenciado que las compresiones realizadas en prono serían tanto o más efectivas que las realizadas en supino con la técnica estándar, presentando la técnica en prono también el beneficio de producir una ventilación pasiva de forma simultánea con la misma maniobra de compresión. La situación que vivimos amerita tomar todas las herramientas con las que contamos, por lo que esta técnica presenta una alternativa viable de realizar en la práctica clínica, sin embargo, hacen falta más estudios al respecto para poder establecer si existe un real beneficio de esta técnica respecto a la técnica clásica. Han surgido recomendaciones de expertos para la RCP en el contexto del paciente COVID-19 en las cuales existe consenso respecto a que es razonable iniciar la reanimación en posición prona en pacientes COVID-19 que se encuentran intubados y siendo ventilados en esta misma posición.
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Humans , Prone Position , Cardiopulmonary Resuscitation/methods , COVID-19ABSTRACT
Background: Current state of practice of medical imaging now encompasses advancesupportive care to patient, in addition to the supportive care offered for the stabilization of patient before radiologic procedures. Advance supportive care, such as Cardiopulmonary Resuscitation (CPR) is offered to patient who may have cardiopulmonary arrests.Objective: To assess the knowledge of cardiopulmonary resuscitation (CPR) among clinical radiography students of a tertiary institution in Sokoto. Methods:A cross section study employing a semi-structured and self-administered questionnaire, consisting of two section, designed with the aim of the study were distributed among 82 clinical radiography students (300 –500 level), in the 2017/2018 academy session of the tertiary institution (Usmanu Danfodiyo University) in Sokoto. The data were extracted using SPSS version 20 and analysed using descriptive and inferential statistics.Results: A total of 75 questionnaire were returned, yielding a response rate of 91.5%. Respondents comprised 53 male and 22 female aged 20 to 34 years with mean age of 27 years. It was observed that 68% of the students had never had a CPR training and about 4% of the respondents knew the recommended compression to ventilation ratio during a CPR. While 1.3% knew the recommended chest compression to be performed each minute when giving CPR. Majority of the respondents (94.7%) were of the opinion, that CPR training should be made mandatory for all clinical radiography students.Conclusion:Base on the evidence presented within this study, there is knowledge gap in the practice of cardiopulmonary resuscitation (CPR) among clinical radiography students, as majority of the students do not have adequate knowledge on the practice of CPR.
ABSTRACT
Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and insports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah,Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimatethe overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiacarrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant wasconsented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills ofCPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ±8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants hadprevious CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey,110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participantsof our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort couldexplain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls.73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED.Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose ofuse in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of theimportance of CPR and AED performance using different pathways for education through media and new legislations.