Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study.

Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.

¿Es importante retirar la ropa para realizar compresiones cardiacas externas? Un estudio de simulación de reanimación cardiopulmonar en maniquí / Is it important to remove clothing for external chest compressions? A cardiopulmonary resuscitation simulation study in mannequin

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Does lying in the recovery position increase the likelihood of not delivering cardiopulmonary resuscitation?

BACKGROUND: Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. AIM: To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. METHODS: Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. RESULT: In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p=0.006 (OR 6.571) detected breathing arrest within 2min. CONCLUSION: The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used.

Estudio cuasiexperimental para evaluar la capacidad de los escolares para utilizar un desfibrilador externo semiautomático a los 6 meses tras un proceso formativo / Quasi-experimental study to assess schoolchildren’s ability to use a semiautomatic external defibrillator 6 months after training

Objetivo: Evaluar la capacidad por parte de los escolares para utilizar un desfibrilador externo semiautomático (DESA) y el tiempo de administración de una desfibrilación a los 6 meses tras un proceso formativo. Métodos: Estudio cuasiexperimental sin grupo control. Se incluyeron niños del tercer ciclo de Educación Primaria sin conocimientos previos en el uso del DESA. Tras aplicar un cuestionario sobre conocimientos previos, se les pidió que usasen el DESA en un maniquí de entrenamiento, midiendo el tiempo que tardaban en encenderlo, colocar los parches y administrar la primera desfibrilación (T0). Se volvió a medir el tiempo tras una sencilla explicación de unos 60 segundos de manera individual (T1) y se repitió la medición de los tiempos pasados seis meses (T2). Resultados: Se incluyeron 253 sujetos, de entre 10 y 13 años, de los cuales 128 (50,6%) fueron niñas. Un 100% de los niños fue capaz de usar el DESA sin formación previa aunque no se tuvieron en cuenta los errores en la colocación de parches en la toma inicial. Los tiempos medios fueron: T0 = 83 (DE 14) s; T1 = 44 (DE 5) s; T2 = 45 (DE 7) s. La diferencia de medias fue: T0-T1 = 39 (DE 13) s (p < 0,001), T0-T2 = 38 (DE 15) s (p < 0,001), T1-T2 = 1,4 (DE 7,5) s (p = 0,010). Conclusiones: Los escolares del tercer ciclo de Educación Primaria son capaces de utilizar un DESA sin formación. Tras una pequeña explicación se reduce significativamente el tiempo en aplicar una descarga eficaz sin cometer errores. Este tiempo apenas aumenta pasados seis meses, por lo que no sería imprescindible realizar formación tan frecuentemente como en el caso de las compresiones torácicas externas (AU)

Objective: To evaluate schoolchildren’s ability to use a semiautomatic external defibrillator (SAED) in terms of how long they take to deliver a shock 6 months after they received training. Methods: Uncontrolled, quasi-experimental study. Schoolchildren in grades 5 and 6 without prior knowledge of how to use a SAED were included. After the children answered a questionnaire about their knowledge, they were asked to position the SAED to treat a training mannequin. We measured the time it took them to switch on the device, place the electrode pads, and deliver the first shock (T0). The children were then individually given a simple explanation lasting approximately 60 seconds, after which we measured the time they took to place the SAED again and deliver a shock (T1). Each child’s time was measured again 6 months later (T2). Results: A total of 253 children aged between 10 and 13 years participated; 128 (50.6%) were girls. All the children were able to use the SAED without prior training, although we did not take into consideration mistakes they made in placing the pads at baseline (T0). The mean times were as follows: T0, 83 (SD 14) seconds; T1, 44 (SD 5) seconds; and T2, 45 (SD 7) seconds. The mean differences between times were as follows: T0–T1, 39 (SD 13) seconds (P < .001); T0–T2, 38 (SD 15) seconds (P < .001); and T1–T2, 1.4 (SD 7.5) seconds (P = .010). Conclusions: Fifth- and sixth-grade primary school students are able to use a SAED without training. After the children received a brief explanation, they were able to deliver an effective shock without committing errors. The time until the first shock scarcely changed after 6 months had passed. We conclude that it would not be necessary to provide training for SAED use as often as is required for manual external chest compressions (AU)

[Quasi-experimental study to assess schoolchildren's ability to use a semiautomatic external defibrillator 6 months after training]. / Estudio cuasiexperimental para evaluar la capacidad de los escolares para utilizar un desfibrilador externo semiautomático a los 6 meses tras un proceso formativo.

OBJECTIVES: To evaluate schoolchildren's ability to use a semiautomatic external defibrillator (SAED) in terms of how long they take to deliver a shock 6 months after they received training. MATERIAL AND METHODS: Uncontrolled, quasi-experimental study. Schoolchildren in grades 5 and 6 without prior knowledge of how to use a SAED were included. After the children answered a questionnaire about their knowledge, they were asked to position the SAED to treat a training mannequin. We measured the time it took them to switch on the device, place the electrode pads, and deliver the first shock (T0). The children were then individually given a simple explanation lasting approximately 60 seconds, after which we measured the time they took to place the SAED again and deliver a shock (T1). Each child's time was measured again 6 months later (T2). RESULTS: A total of 253 children aged between 10 and 13 years participated; 128 (50.6%) were girls. All the children were able to use the SAED without prior training, although we did not take into consideration mistakes they made in placing the pads at baseline (T0). The mean times were as follows: T0, 83 (SD 14) seconds; T1, 44 (SD 5) seconds; and T2, 45 (SD 7) seconds. The mean differences between times were as follows: T0-T1, 39 (SD 13) seconds (P < .001); T0-T2, 38 (SD 15) seconds (P < .001); and T1-T2, 1.4 (SD 7.5) seconds (P = .010). CONCLUSION: Pulse CO-oximetry contributed to the prehospital emergency care of these patients by influencing the decision to transfer the patient to a hospital.

OBJETIVO: Evaluar la capacidad por parte de los escolares para utilizar un desfibrilador externo semiautomático (DESA) y el tiempo de administración de una desfibrilación a los 6 meses tras un proceso formativo. METODO: Estudio cuasiexperimental sin grupo control. Se incluyeron niños del tercer ciclo de Educación Primaria sin conocimientos previos en el uso del DESA. Tras aplicar un cuestionario sobre conocimientos previos, se les pidió que usasen el DESA en un maniquí de entrenamiento, midiendo el tiempo que tardaban en encenderlo, colocar los parches y administrar la primera desfibrilación (T0). Se volvió a medir el tiempo tras una sencilla explicación de unos 60 segundos de manera individual (T1) y se repitió la medición de los tiempos pasados seis meses (T2). RESULTADOS: Se incluyeron 253 sujetos, de entre 10 y 13 años, de los cuales 128 (50,6%) fueron niñas. Un 100% de los niños fue capaz de usar el DESA sin formación previa aunque no se tuvieron en cuenta los errores en la colocación de parches en la toma inicial. Los tiempos medios fueron: T0 = 83 (DE 14) s; T1 = 44 (DE 5) s; T2 = 45 (DE 7) s. La diferencia de medias fue: T0-T1 = 39 (DE 13) s (p < 0,001), T0-T2 = 38 (DE 15) s (p < 0,001), T1-T2 = 1,4 (DE 7,5) s (p = 0,010). CONCLUSIONES: Fifth- and sixth-grade primary school students are able to use a SAED without training. After the children received a brief explanation, they were able to deliver an effective shock without committing errors. The time until the first shock scarcely changed after 6 months had passed. We conclude that it would not be necessary to provide training for SAED use as often as is required for manual external chest compressions.