Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is a vital link in the chain of survival for out-of-hospital cardiac arrest (OHCA); however, there are racial/ethnic disparities in the provision of bystander CPR. Approximately 32% of Hispanics perform CPR when confronted with cardiac arrest, whereas approximately 41% of non-Hispanics perform CPR. Public education, via the Internet, may be critical in improving the performance of bystander CPR among Hispanics. The objective of this study was to evaluate the availability and quality of CPR-related literature for primary Spanish-speaking individuals on the Internet. METHODS: Two search engines (Google and Yahoo!) and a video-site (YouTube) were searched using the following terms: "resucitacion cardiopulmonar" and "reanimacion cardiopulmonar." Inclusion criteria were: education of CPR technique. Exclusion criteria were: instruction on pediatric CPR technique, failure to provide any instruction on CPR technique, or duplicated website. Data elements were collected on the content and quality of the websites and videos, such as assessing scene safety, verifying responsiveness, activating EMS, properly positioning hands on chest, performing accurate rate and depth of compressions. RESULTS: Of the 515 websites or videos screened, 116 met criteria for inclusion. The majority of websites (86%; 95% Confidence Interval [CI] 79-92%) educated viewers on traditional bystander CPR (primarily, 30:2 CPR), while only 14% (95% CI 9-21%) taught hands-only CPR. Of websites that used video (N=62), 84% were conducted in Spanish and 16% in English. The quality of CPR education was generally poor (median score of 3/6, IQR of 3.0). Only half of websites properly educated on how to check responsiveness, activate EMS and position hands on chest. Eighty-eight percent of websites failed to educate viewers on assessing scene safety. The majority of websites had improper or no education on both rate and depth of compressions (59% and 63%, respectively). Only 16% of websites included 5 or more quality markers for proper bystander CPR. CONCLUSIONS: A small proportion of internet resources have high quality CPR education for a Spanish-speaking population. More emphasis should be placed on improving the quality of educational resources available on the Internet for Spanish-speaking populations, and with particular emphasis on current basic life support recommendations.

Availability and potential impact of international rotations in emergency medicine residency programs.

BACKGROUND: Interest in international emergency medicine (IEM) is growing. With the globalization of medicine, IEM as a field has expanded from disaster relief efforts to opportunities for resident education. Numerous accounts have been published voicing the educational benefits of international rotations (IRs). As such, many residencies now offer opportunity for IRs. OBJECTIVE: To evaluate the availability and utilization of IRs in emergency medicine (EM) residency programs. METHODS: EM residency program directors were surveyed from the 126 Accreditation Council for Graduate Medical Education-accredited programs with ≥2 years of residency graduates. Directors were asked about availability of IR, categorized as: 1) required; 2) elective (with or without pre-designated sites); or 3) not available. RESULTS: One hundred eleven (88%) program directors reported data on 2240 graduates over 2 years. IRs were offered by 101 (91%) programs. No program required an IR. Among programs offering IRs, most (69%) did not have pre-designated sites. Eighty-nine of 101 programs (88%) allowing IRs had at least one resident completing an IR; 23 of 111 programs (21%) had more than 30% resident participation in IRs. Programs offering IRs at pre-designated sites had 210 of 727 (29%) residents complete an IR, compared to 272 of 1469 (19%) in programs without pre-designated sites (p < 0.001). Four-year programs had twice as many IR participants (32%) compared to 3-year programs (17%; p < 0.001). CONCLUSIONS: More residents participated in IRs when a pre-designated site was available compared to programs without. This suggests that programs interested in supporting IRs consider developing pre-designated sites to accommodate residents.

Vasopressors in cardiac arrest: a systematic review.

OBJECTIVES: To review the literature addressing whether the use of vasopressors improves outcomes in patients who suffer cardiac arrest. METHODS: Databases were searched using the terms: "(adrenaline or noradrenaline or vasopressor) and (heart arrest or cardiac arrest) and therapy". Inclusion criteria were human studies, controlled trials, meta-analysis or case series. Exclusion criteria were articles with no abstract, abstract-only citations without accompanying article, non-English abstracts, vasopressor studies without human clinical trials, case reports, reviews, and articles addressing traumatic arrest. RESULTS: 1603 papers were identified of which 53 articles were included for review. The literature addressed 5 main therapeutic questions. (1) Outcomes comparing any vasopressor to placebo. (2) Outcomes comparing vasopressin (alone or in combination with epinephrine) to epinephrine. (3) Outcomes comparing high dose epinephrine to standard dose epinephrine. (4) Outcomes comparing any alternative vasopressor to epinephrine. (5) Outcomes examining vasopressor use in pediatric cardiac arrest. CONCLUSION: There are few studies that compare vasopressors to placebo in resuscitation from cardiac arrest. Epinephrine is associated with improvement in short term survival outcomes as compared to placebo, but no long-term survival benefit has been demonstrated. Vasopressin is equivalent for use as an initial vasopressor when compared to epinephrine during resuscitation from cardiac arrest. There is a short-term, but no long-term, survival benefit when using high dose vs. standard dose epinephrine during resuscitation from cardiac arrest. There are no alternative vasopressors that provide a long-term survival benefit when compared to epinephrine. There is limited data on the use of vasopressors in the pediatric population.