[Advanced life support for cardiac arrest beyond the algorithm].

In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial, but are not supported by firm scientific evidence.

Persisting effect of community approaches to resuscitation.

BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare the bystander BLS rate and survival after OHCA on Bornholm in a 3-year follow-up period after the intervention took place. METHODS: Data on OHCA on Bornholm were collected from September 28th, 2010 to September 27th, 2013 and compared to data from the intervention period, September 28th, 2008 to September 27th, 2010. RESULTS: The bystander BLS rate for non-EMS witnessed OHCAs with presumed cardiac aetiology was significantly higher in the follow-up period (70% [95% CI 61-77] vs. 47% [95% CI 37-57], p=0.001). AEDs were deployed in 22 (18%) cases in the follow-up period and a shock was provided in 13 cases. There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). CONCLUSION: In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival.

Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted media campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased. METHODS: BLS and AED courses were offered and the local television station had broadcasts about resuscitation in this study community. A telephone enquiry assessed the attitudes towards different aspects of resuscitation among randomly selected citizens before (2008) and after the project (2009). RESULTS: For responses from 2008 (n = 824) to 2009 (n = 815), there was a significant increase in the proportions who had participated in a BLS course within the past 5 years, from 34% to 49% (p = 0.0001), the number willing to use an AED on a stranger (p < 0.0001), confident at providing chest compressions (p = 0.03), and confident at providing mouth-to-mouth ventilations (MMV) (p = 0.048). There was no significant change in the proportions willing to provide chest compressions (p = 0.15), MMV (p = 0.23) or confident at recognizing a cardiac arrest (p = 0.09). The most frequently reported reason for not being willing to provide chest compressions, MMV and use an AED was insecurity about how to perform the task. CONCLUSION: A targeted media campaign and widespread education can significantly increase the willingness to use an AED, and the confidence in providing chest compressions and MMV. The willingness to provide chest compressions and MMV may be less influenced by a targeted campaign.

Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting.

BACKGROUND: Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. METHODS: The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. RESULTS: On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40-50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01). During the rhythm analysis, 65% did not perform any visual or verbal safety check. CONCLUSION: The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.

Distributing personal resuscitation manikins in an untrained population: how well are basic life support skills acquired?

BACKGROUND: Self-instruction with a DVD and a simple personal manikin is an effective alternative to traditional basic life support (BLS) courses. Objective To evaluate the effect of distributing DVD training kits to untrained laypersons. BLS skills were compared according to 2005 guidelines for resuscitation after 3.5 months with those obtained in untrained laypersons who completed the same course with instructor facilitation. METHODS: BLS skills of 55 untrained laypersons were assessed using the Laerdal ResusciAnne and PC Skill Reporting System in a 3 min test and a total score (12-48 points) was calculated. The participants received a DVD training kit without instructions. The test was repeated after 3.5 months. Data were compared with data from a previous published study where participants completed the same course in groups with instructor facilitation. RESULTS: There was no statistically significant difference in the total score after 3.5 months. The 'DVD-self-instructor' group obtained 33 (29-37) points and the 'DVD-with instructor' group obtained 34 (32-37) points, p=0.16. The 'DVD-with instructor' group performed significantly better in checking responsiveness and had a significantly shorter 'total hands-off time' (s) (85 (76-94) vs 96 (82-120), p=0.002) and delay until first compression or ventilation group (29 s (17-40) vs 33 s (22-48), p=0.04). CONCLUSIONS: Since no significant difference in total BLS score was found after 3.5 months between untrained laypersons who either completed a DVD-based BLS course in groups with instructor facilitation or received the same DVD training kit without instruction, the latter seems more efficient.

Acquisition and retention of basic life support skills in an untrained population using a personal resuscitation manikin and video self-instruction (VSI).

BACKGROUND: Video-based self-instruction (VSI) with a 24-min DVD and a personal resuscitation manikin solves some of the barriers associated with traditional basic life support (BLS) courses. No accurate assessment of the actual improvement in skills after attending a VSI course has been determined, and in this study we assess the skill improvement in laypersons undergoing VSI. METHODS: The BLS skills of 68 untrained laypersons (high school students, their teachers and persons excluded from mainstream society) were assessed using the Laerdal ResusciAnne and PC Skill Reporting System 2.0 in a 3 min test. A total score (12-48 points) was calculated and 12 different variables were recorded. The participants attended a 24-min VSI course (MiniAnne, Laerdal) and took home the DVD and manikin for optional subsequent self-training. We repeated the test 3 1/2-4 months later. RESULTS: There was a significant increase in the total score (p<0.0001) from 26.5 to 34 points. The participants performed significantly better in checking responsiveness, opening the airway, checking for respiration and using the correct compression/ventilation ratio (all p-values<0.001). The compression depth improved from 38 mm to 49.5 mm and the total number of compressions increased from 67 to 141. The ventilation volume and the total number of ventilations increased, and total "hands-off" time decreased from 120.5 s to 85 s. CONCLUSIONS: Untrained laypersons attending a 24 min DVD-based BLS course have a significantly improved BLS performance after 3 1/2-4 months compared to pre-test skill performance. Especially the total number of compressions improved and the hands-off time decreased.

[Have the 2005 guidelines for resuscitation been implemented?]. / Er guidelines 2005 for hjertestopbehandling implementeret?

INTRODUCTION: In 2005, new international evidence-based guidelines for cardiopulmonary resuscitation (CPR) were published by the International Liaison Committee on Resuscitation (ILCOR). The aim of these new guidelines is to improve the quality of care and, thereby, the outcome from cardiac arrest. This necessitates that the guidelines are known and implemented in clinical practice. The purpose of this investigation is to elucidate the extent of implementation of Guidelines 2005 (G2005) among doctors on Cardiac Arrest Teams (CAT) one year after the publication. In addition, the date of implementation is examined among medical emergency services and major providers of basic life support (BLS) courses. MATERIAL AND METHODS: A telephone enquiry about CPR among CAT doctors on-duty. Ambulance services and BLS-course providers are contacted by e-mail. RESULTS: Approximately 70% of the doctors were able to answer simple and essential topics on CPR, e.g. compression/ventilation ratio and the number of shocks in a sequence in accordance with G2005. The ambulance service, Falck A/S, implemented G2005 during 2007, while the other ambulance services implemented G2005 within six months after publication. The majority of BLS-course providers implemented the guidelines one year after their publication. CONCLUSION: One year after the publication of G2005, there is limited knowledge of the guidelines among doctors on duty. The study does not give any explanation for the lack of implementation. The barriers to implementation should be clarified, and future guidelines should be accompanied by an active strategy for implementation.

[Intraosseous access in adults--an alternative if conventional vascular access is difficult?]. / Intraossøs adgang hos voksne--et alternativ ved vanskelig karadgang?

Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.

Laypersons may learn basic life support in 24min using a personal resuscitation manikin.

BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation and the challenge is to find the most efficient one. AIMS: To compare the efficiency of a 24 min instruction using a DVD-based self-training BLS course combined with a simple, take-home resuscitation manikin to a conventional 6h course for teaching BLS to laypersons. METHODS: In total, 238 laypersons (age 21-55 years) without previous BLS-training were allocated into two groups: one group received 24 min of instruction using a DVD-based instruction tool on a big screen combined with a BLS self-training device, Laerdal MiniAnne manikin (MAM), before taking home the instruction material for subsequent self-training. The second group attended a conventional 6 h BLS course (6 HR). After 3 months BLS skills were assessed on a Laerdal ResusciAnne manikin using the Laerdal PC Skill reporting System, and a total score was calculated. RESULTS: There was no significant difference between groups in BLS performance using the total score. Assessment of breathing was performed significantly more often in the 6 HR-group (91% versus 72%, P=0.03). In the MAM-group, average inflation volume and chest compression depth were significantly higher (844 mL versus 524 mL, P=0.006, and 45 mm versus 39 mm, P=0.005). CONCLUSIONS: When assessed after 3 months, a 24 min DVD-based instruction plus subsequent self-training in BLS appears equally effective compared to a 6h BLS course and hence is more efficient.