Resuscitation
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Letter
Dispatcher-assistance in lay rescuer infant CPR: Promoting the enhancement of the guiding protocol.
In the 2021 guidelines of the European Resuscitation Council (ERC) on infant CPR, a two-thumb encircling technique (TTET) is advised instead of the former two-finger technique (TFT), even for single rescuers. It is however unclear if this is also feasible and effective in case of dispatcher-assisted CPR by untrained bystanders and was explored in a cross-over infant manikin study including CPR-trained students and lay people. ⋯ Results suggest it is feasible to advice single lay rescuers to perform TTET as part of a dispatcher-assisted CPR protocol, although we identified an ongoing risk, regardless of the technique advised, of suboptimal compression depth. Further research should be performed to confirm these preliminary data and explore optimal protocols for dispatcher-assisted infant CPR.
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CT perfusion is a valuable tool for evaluating cerebrovascular diseases, but its role in patients with hypoxic ischaemic encephalopathy is unclear. This study aimed to investigate 1) the patterns of cerebral perfusion changes that may occur early on after successful resuscitation, and 2) their correlation with clinical outcome to explore their value for predicting outcome. ⋯ This pilot study identified various perfusion patterns in patients after resuscitation, indicative of circulatory changes associated with post-cardiac-arrest brain injury. After validation, certain patterns could potentially be used in conjunction with other prognostic markers for stratifying patients and adjusting personalized treatment following cardiopulmonary resuscitation. Normal brain perfusion within 12 h after resuscitation is predictive of favourable outcome with high specificity.
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Out-of-hospital cardiac arrest (OHCA) patients from minoritized communities have lower rates of initial shockable rhythm, which is linked to favorable outcomes. We sought to evaluate the importance of initial shockable rhythm on OHCA outcomes and factors that mediate differences in initial shockable rhythm. ⋯ We included 22,730 OHCAs from majority White (21.1% initial shockable rhythm), 4,749 from majority Black (15.3% shockable), and 16,054 majority Hispanic/Latino (16.1% shockable) communities. Odds of favorable neurologic outcome were lower for majority Black (0.4 [0.3-0.5]) and Hispanic/Latino (0.6 [0.6-0.7]). While adjusting for bCPR minimally changed outcome odds, adjusting for shockable rhythm increased odds for Black (0.5 [0.4-0.5]) and Hispanic/Latino (0.7 [0.6-0.8]) communities. On mediation analysis for majority Black, the top mediators of initial shockable rhythm were public location (14.6%), bystander witnessed OHCA (11.6%), and female gender (5.7%). The top mediators for majority Hispanic/Latino were bystander-witnessed OHCA (10.2%), public location (3.52%), and bystander CPR (3.49%), CONCLUSION: Bystander-witnessed OHCA and public location were the largest mediators of shockable rhythm for OHCAs from minoritized communities.
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Achievement of adequate ventilation skills during training courses is mainly based on instructors' perception of attendees' capability to ventilate with correct rate and chest compression:ventilation ratio, while leading to chest raising, as evidence of adequate tidal volume. Accuracy in evaluating ventilation competence was assessed in 20 ACLS provider course attendees, by comparing course instructors' evaluation with measures from a ventilation feedback device. ⋯ Deploying quality ventilation during CPR is a skill whose acquisition starts with effective training. Therefore, course instructors' capability to accurately evaluate attendees' ventilation maneuvers is crucial.
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In patients undergoing cardiopulmonary resuscitation (CPR) after an Out-of-Hospital Cardiac Arrest (OHCA), intrathoracic airway closure can impede ventilation, adversely affecting patient outcomes. This explorative study investigates the evolution of intrathoracic airway closure by analyzing the lower inflection point (LIP) during the inspiration phase of CPR, aiming to identify the potential thresholds for alveolar recruitment. ⋯ These explorative data demonstrate a predominantly negative trajectory in LIP evolution during CPR, suggesting potential challenges in maintaining airway patency. Limitations include a small sample size and sensor recording issues. Further research is warranted to explore the evolution of LIP and its implications for personalized ventilation strategies in CPR.