Efficacy of distance training program for cardiopulmonary resuscitation utilizing smartphone application and home delivery system.

AIM OF THE STUDY: Community cardiopulmonary resuscitation (CPR) education is important for laypersons. However, during the COVID-19 pandemic, with social distancing, conventional face-to-face CPR training was unavailable. We developed a distance learning CPR training course (HEROS-Remote) using a smartphone application that monitors real-time chest compression quality and a home delivery collection system for mannikins. This study aimed to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality with that of conventional CPR training. METHODS: We applied layperson CPR education with HEROS-Remote and conventional education in Seoul during the COVID-19 pandemic. Both groups underwent a 2-min post-training chest compression test, and we tested non-inferiority. Chest compression depth, rate, complete recoil, and composite chest compression score was measured. Trainees completed a satisfaction survey on CPR education and delivery. The primary outcome was the mean chest compression depth. RESULTS: A total of 180 trainees were enrolled, with 90 assigned to each training group. Chest compression depth of HEROS-Remote training showed non-inferiority to that of conventional training (67.4 vs. 67.8, p = 0.78), as well as composite chest compression score (92.7 vs. 95.5, p = 0.16). The proportions of adequate chest compression depth, chest compression rate, and chest compressions with complete chest recoil were similar in both training sessions. In the HEROS-Remote training, 90% of the trainees were satisfied with CPR training, and 96% were satisfied with the delivery and found it convenient. CONCLUSION: HEROS-Remote training was non-inferior to conventional CPR training in terms of chest compression quality. Distance learning CPR training using a smartphone application and mannikin delivery had high user satisfaction and was logistically feasible.

The impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: Which survival chain factor contributed the most?

OBJECTIVES: In many communities, out-of-hospital cardiac arrest (OHCA) survival outcomes decreased after the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify and compare the impacts of each survival chain factor on the change of survival outcomes after COVID-19. METHODS: Using a Korean out-of-hospital cardiac arrest registry, we analyzed OHCA patients whose arrest was not witnessed by emergency medical service (EMS) providers between 2017 and 2021. Because lack of hospital and survival information in 2021, the 2021 data were used only to identify the expected trend. We developed a prediction model for survival to discharge using patients from 2017 to 2019 (Pre-COVID-19 set) and validated it using patients from 2020 (post-COVID-19 set). Using Utstein elements, a stepwise logistic regression model was constructed, and discrimination and calibration were evaluated by c-statistics and scaled Brier score. Using the distribution change of predictors from one year before the pandemic (2019) to post-COVDI-19, we calculated the magnitude of survival difference according to each predictor's distribution change using the marginal standardization method. RESULTS: Among 83,273 patients (mean age 67.2 years and 64.3% males), 61,180 and 22,092 patients belonged to pre-COVOD-19 and post-COVID-19 sets. Survival to discharge was 5019 (8.2%) in pre-COVID-19 set and 1457 (6.6%) in post-COVID-19 set. The proportion of bystander cardiopulmonary resuscitation was 59.0% in the pre-COVID-19 set and 61.0% in the post-COVID-19 set. The median (interquartile range) response time was 7 (5-9) minutes in the pre-COVID-19 set and 8 (6-10) minutes in the post-COVID-19 set. The area under the receiver operating characteristic (AUROC) curve (95% confidence interval) was 0.907 (0.902-0.912) in the pre-COVID-19 set, and 0.924 (0.916-0.931) in the post-COVID-19 set, and scaled Brier score were 0.39 in pre-COVID-19 sets, and 0.40 in the post-COVID-19 set. Among various predictors, EMS factors showed the highest impact. Response time and on-scene management of EMS showed the highest impact on decreased survival. A similar trend was also expected in the 2021. CONCLUSION: The effort to create a rapid response system for OHCA patients could have priority for the recovery of survival outcomes in OHCA patients in the post-COVID-19 period. Further studies to recover survival outcomes of OHCA are warranted.

Effect of social distancing on injury incidence during the COVID-19 pandemic: an interrupted time-series analysis.

OBJECTIVES: To evaluate the effects of social distancing on the incidence and characteristics of injuries during the COVID-19 pandemic. DESIGN AND SETTING: This cross-sectional study used the National Emergency Department Information System (NEDIS) database. PARTICIPANTS: Injured patients who visited all 402 emergency departments (EDs) between 29 February and 29 May 2020 (after-distancing), and in the corresponding period in 2019 (before distancing) to control for seasonal influences. OUTCOME MEASURES: The study outcome was the incidence of injury. Using the interrupted time-series analysis models, we analysed weekly trends of study outcomes in both periods (before and after distancing), the step change (the effect of intervention), and the slope change over two periods (the change in the effect over time). RESULTS: The incidence rates of injury per 100 000 person-days were 11.2 and 8.6 in the before-distancing and after-distancing periods, respectively. In the after-distancing period, the incidence rate of injury decreased (step change -3.23 (95% CI -4.34 to -2.12) per 100 000 person-days) compared with the before-distancing period, while the slope change was 0.10 (95% CI 0.04 to 0.24). The incidence rate ratios of all injuries and intentional injuries for the after-distancing period were 0.67 (95% CI 0.60 to 0.75) and 1.28 (95% CI 1.18 to 1.40), respectively, compared with the before-distancing period. CONCLUSIONS: Fewer injuries occurred after the implementation of social distancing programme compared with the same period in the previous year. However, this effect gradually decreased postimplementation.

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019.

BACKGROUNDS: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. METHODS: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. RESULTS: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). CONCLUSION: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.