The nationwide impact of COVID-19 on life support courses. A retrospective evaluation by Resuscitation Council UK.

Aim: To determine the impact of the COVID-19 pandemic on Resuscitation Council UK Advanced Life Support (ALS) and Immediate Life Support (ILS) course numbers and outcomes. Methods: We conducted a before-after study using course data from the Resuscitation Council UK Learning Management System between January 2018 and December 2021, using 23 March 2020 as the cut-off between pre- and post-pandemic periods. Demographics and outcomes were analysed using chi-squared tests and regression models. Results: There were 90,265 ALS participants (51,464 pre-; 38,801 post-) and 368,140 ILS participants (225,628 pre-; 142,512 post-). There was a sharp decline in participants on ALS/ILS courses due to COVID-19. ALS participant numbers rebounded to exceed pre-pandemic levels, whereas ILS numbers recovered to a lesser degree with increased uptake of e-learning versions. Mean ALS course participants reduced from 20.0 to 14.8 post-pandemic (P < 0.001).Post-pandemic there were small but statistically significant decreases in ALS Cardiac Arrest Simulation Test pass rates (from 82.1 % to 80.1 % (OR = 0.90, 95 % CI = 0.86-0.94, P < 0.001)), ALS MCQ score (from 86.6 % to 86.0 % (mean difference = -0.35, 95 % CI -0.44 to -0.26, P < 0.001)), and overall ALS course results (from 95.2 %to 94.7 %, OR = 0.92, CI = 0.85-0.99, P = 0.023). ILS course outcomes were similar post-pandemic (from 99.4 % to 99.4 %, P = 0.037). Conclusion: COVID-19 caused a sharp decline in the number of participants on ALS/ILS courses and an accelerated uptake of e-learning versions, with the average ALS course size reducing significantly. The small reduction in performance on ALS courses requires further research to clarify the contributing factors.

Is Use Of An Interactive Voice Server In An Emergency Medical Dispatch Center An Efficient And Safe Measure?

Introduction: In the first wave of COVID-19 pandemic, Emergency Medical Dispatch Centers (EMDC) faced an influx of calls. During this time, with the scope of handling emergency calls more quickly, it was decided to use an Interactive Voice Server (IVS). The objective of this study was to identify whether the implementation of an IVS is efficient and safe. Method(s): From 20/03/19 until 20/04/26, an IVS was activated between 8 AM and midnight. IVS offered the caller to choose either 1-press the 'zero' key for Coronavirus Syndrome with no respiratory difficulties;or 2-stay on line for any other reason. If the caller typed 'zero', the call was directed to a 'crisis dispatcher' specially trained to handle COVID cases. If he stayed on line, his call was placed in the same queueing list as all emergency calls and handled by a "conventional dispatcher". All medical dispatch files picked up during IVS activation period were included and classified in 2 groups: "IVS Yes" if caller pressed 'zero' and "IVS No" if not. Patient's age, gender and profile of the caller (patient or third party) were collected. The level of severity of the patients was assessed upon the dispatcher' decision ranging from sending an Advanced Life Support ambulance (ALS), a Basic Life Support ambulance (BLS) or no transport. Data were compared between the 2 groups with Chi-square tests. Result(s): 2846 callers were in the group "IVS Yes" and 12111 in "IVS No". Main results are in table 1. Conclusion(s): IVS allowed almost 15% of calls to be directed to a specialized provider where they waited to be processed by staff trained within a few days to deal exclusively with COVID cases. This has led to decrease the number of calls handled by the conventional dispatch and allowed more time to respond to severe emergency calls. Moreover, because only 0.07% "IVS Yes" needed an ALS ambulance, we can assume that the use of IVS is safe. IVS is therefore an effective tool, which allows safe triage of less serious patients and frees up time to answer to severe calls.

Cardiopulmonary resuscitation.

Performing cardiopulmonary resuscitation is a key competency for healthcare professionals. Training in immediate and advanced life support is a requirement for UK doctors; this is depicted in the Foundation training programme competencies and in the Internal Medicine Training curriculum. It requires being able to identify unwell patients, perform a structured assessment and treatment approach, master relevant procedural aspects and demonstrate non-technical skills including leading the resuscitation team. The Resuscitation Council UK has recently provided updated guidance on basic and advanced life support. These guidelines align with similar international guidelines, taking into account evidence from clinical trials of cardiac arrest management and national data on cardiac arrest outcomes in the community and in the hospital. The guidance includes considerations regarding individuals with suspected or confirmed coronavirus disease (COVID-19). The complex ethical aspects around escalation of care, advance care planning, 'Do Not Attempt Cardiopulmonary Resuscitation' decisions and communication with patients and their loved ones are also discussed. This chapter summarizes the current guidance on cardiopulmonary resuscitation.

Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review.

AIM: To perform a systematic review of cardiopulmonary resuscitation (CPR) and/or defibrillation in the prone position compared to turning the patient supine prior to starting CPR and/or defibrillation. METHODS: The search included PubMed, Embase, Web of Science, Cochrane, CINAHL Plus, and medRxiv on December 9, 2020. The population included adults and children in any setting with cardiac arrest while in the prone position. The outcomes included arterial blood pressure and end-tidal capnography during CPR, time to start CPR and defibrillation, return of spontaneous circulation, survival and survival with favorable neurologic outcome to discharge, 30 days or longer. ROBINS-I was performed to assess risk of bias for observational studies. RESULTS: The systematic review identified 29 case reports (32 individual cases), two prospective observational studies, and two simulation studies. The observational studies enrolled 17 patients who were declared dead in the supine position and reported higher mean systolic blood pressure from CPR in prone position (72 mmHg vs 48 mmHg, p < 0.005; 79 ± 20 mmHg vs 55 ± 20 mmHg, p = 0.028). One simulation study reported a faster time to defibrillation in the prone position. Return of spontaneous circulation, survival to discharge or 30 days were reported in adult and paediatric case reports. Critical risk of bias limited our ability to perform pooled analyses. CONCLUSIONS: We identified a limited number of observational studies and case reports comparing prone versus supine CPR and/or defibrillation. Prone CPR may be a reasonable option if immediate supination is difficult or poses unacceptable risks to the patient.

Adult respiratory syncytial virus infection and hypoxic cardiac arrest – Coexistent or causal?

Purpose of the study: Respiratory syncytial virus (RSV) is a wellknown pathogen in pediatric patients. (1) However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. (2). Methods:We reviewed a patient suffering from cardiac arrest (CA) and acute RSV infection who was admitted to the Department of Emergency Medicine, Medical University of Vienna, Austria. Results: A 74-year-old male patient complained about dyspnea and later went into CA. Bystander BLS was conducted for 7 minutes, and arriving EMS performed advanced life support (ALS). The initial rhythm check showed pulseless electrical activity. After further 6 minutes of ALS, sustained return of spontaneous circulation (ROSC) was achieved, and the patient was transported to the emergency department (ED). At the ED, the ECG showed no ischemia-like patterns, and point-of-care ultrasound revealed a highly reduced left ventricular function. Laboratory results showed signs of inflammation, and a routine PCR turned out positive for RSV. Awhole body computed tomography revealed no acute pathology, and before a background of chronic pulmonary disease, the CA event was deemed as hypoxic caused by exacerbation of the chronic pulmonary pathologies either parallel to- or directly through an acute RSV infection. Conclusion: An RSV infection should be considered during post- ROSC in adult patients with presumed hypoxic etiology of CA. From a public health perspective, an immune-naivety for RSV caused by the COVID-19 pandemic may potentially induce a rise in cases, morbidity, and mortality in the future.

Instructor Development Workshops for Advanced Life Support Training Courses Held in a Fully Virtual Space: Observational Study.

BACKGROUND: Various face-to-face training opportunities have been lost due to the COVID-19 pandemic. Instructor development workshops for advanced resuscitation (ie, advanced life support) training courses are no exception. Virtual reality (VR) is an attractive strategy for remote training. However, to our knowledge, there are no reports of resuscitation instructor training programs being held in a virtual space. OBJECTIVE: This study aimed to investigate the learning effects of an instructor development workshop that was conducted in a virtual space. METHODS: In this observational study, we created a virtual workshop space by using NEUTRANS (Synamon Inc)-a commercial VR collaboration service. The instructor development workshop for the advanced life support training course was held in a virtual space (ie, termed the VR course) as a certified workshop by the Japanese Association of Acute Medicine. We asked 13 instructor candidates (students) who participated in the VR course to provide a workshop report (VR group). Reports from a previously held face-to-face workshop (ie, the face-to-face course and group) were likewise prepared for comparison. A total of 5 certified instructor trainers viewed and scored the reports on a 5-point Likert scale. RESULTS: All students completed the VR course without any problems and received certificates of completion. The scores for the VR group and the face-to-face group did not differ at the level of statistical significance (median 3.8, IQR 3.8-4.0 and median 4.2, IQR 3.9-4.2, respectively; P=.41). CONCLUSIONS: We successfully conducted an instructor development workshop in a virtual space. The degree of learning in the virtual workshop was the same as that in the face-to-face workshop.

Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain.

OBJECTIVES: The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study is to evaluate the performance of the specialty of Anesthesiology in the management of CPR during the pandemic. METHODS: A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members. RESULTS: 225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26,3% have attended some cardiac arrest, 16,8% of the participants admitted to lead the manoeuvres, 16,8% detailed that it had been another department, and 66,2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anesthesia should lead the in-hospital CPR. CONCLUSION: The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.

[Executive summary]. / Kurzfassung: Leitlinien des European Resuscitation Council 2021.

Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.

[Cardiopulmonary resuscitation during the COVID-19 pandemic in Spain]. / Resucitación cardiopulmonar durante la pandemia por COVID-19 en España.

OBJECTIVES: The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study was to evaluate the performance of the specialty of Anaesthesiology in the management of CPR during the pandemic. METHODS: A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members. RESULTS: 225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26.3% have attended some cardiac arrest, 16.8% of the participants admitted to lead the manoeuvres, 16.8% didn't participate in the CPR, and 66.2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anaesthesia should lead the in-hospital CPR. CONCLUSION: The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.

Educational theory and its application to advanced life support courses: a narrative review.

The knowledge, skills and attitudes taught on Advanced Life Support (ALS) courses are an important learning requirement for healthcare professionals who are involved with the care of acutely unwell patients. It is essential that the course design and delivery is appropriately planned to ensure that it optimises the learning opportunities for all learners. This paper offers a narrative review of how the application of educational theory has positively influenced the evolution of ALS courses since their inception in the late twentieth century. By embracing and understanding the relevant educational theories, the ALS course design has transformed from a predominantly lecture-based and behaviourist approach, to a more participative and social constructivist approach to learning. In addition, the advent of smarter technology and the challenges posed by the COVID-19 pandemic have facilitated a more connectivist approach to learning. It can therefore be demonstrated that the ALS course is influenced by a combination of theoretical approaches and provides a diverse framework of teaching and learning strategies that cater for many individual learning styles. Any further evolution and development of the course should be based upon contemporary educational theory to ensure that it remains fit for purpose.