Drowning and Cardiopulmonary Resuscitation. Relevance of the Problem and Effect of Physical Training on Resuscitation Quality

"Every hour, every day, more than 40 people lose their lives by drowning." These are the first words of one of the different Drowning reports published by the World Health Organization, which consideres Drowning as a neglected public health issue. Cardiopulmonary resuscitation is the main early treatment in the unconscious not-breating Drowning patient, and it is broached from the Sport Sciences field. Therefore, in this Thesis by Compendium of Publications, the aim was to review the main important factors related to Drowning. In addition, acute muscle fatigue casued by cardiopulmonary resuscitation was assesed just as the effect of a strength-training program in resuscitation quality

Replacement of animal models of cardiac arrest and resuscitation strategies using a computer simulation

This doctoral thesis explores cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) from a multidisciplinary perspective, with a focus on three main objectives: enhancing the Interdisciplinary Collaboration in Systems Medicine (ICSM) simulation suite, investigating the pathophysiology of CA, and proposing an alternative to animal models in CA and CPR research. The ICSM simulation suite was significantly improved, with additions such as a thoracic model for chest compressions, multiple organ tissue compartments, a vasculature equation accounting for resistance changes, circulatory transport delays, retrograded blood flow during CPR, and respiratory and cardiovascular control mechanisms. Utilizing the enhanced ICSM simulation suite, a series of studies were conducted to examine various aspects of CPR strategies, all with the aim of improving resuscitation outcomes. These studies encompassed investigations into the impact of positive end-expiratory pressure (PEEP) on cardiac output during CPR, the effects of chest compression rate, depth, and duty cycle, the influence of the precipitating aetiology on CPR strategy optimization, and the comparison of personalized CPR strategies to current guidelines. The research also quantitatively identified the effect of CPR parameters on cardiac output, with end compression force and positive end expiratory pressure emerging as significant contributors. The validation of the ICSM simulation suite thoracic model using individual haemodynamic recordings of a patient undergoing CPR demonstrated its capacity to simulate individualized patient data for retrospective identification of optimized CPR protocols. These outcomes collectively emphasize the potential of computational models, particularly the ICSM simulation suite, to revolutionize CA and CPR research by providing humane, informative, and personalized alternatives to traditional animal models. The findings of this research suggest that the ICSM simulation suite offers a valuable alternative to animal models in the study of CA and CPR. This computational model allows for the simulation and investigation of personalized CPR strategies, which can be tailored to individual patients' need

Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest

Background In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of −0.2 percentage points (95% confidence interval, −1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.

Replacement of animal models of cardiac arrest and resuscitation strategies using a computer simulation

This doctoral thesis explores cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) from a multidisciplinary perspective, with a focus on three main objectives: enhancing the Interdisciplinary Collaboration in Systems Medicine (ICSM) simulation suite, investigating the pathophysiology of CA, and proposing an alternative to animal models in CA and CPR research. The ICSM simulation suite was significantly improved, with additions such as a thoracic model for chest compressions, multiple organ tissue compartments, a vasculature equation accounting for resistance changes, circulatory transport delays, retrograded blood flow during CPR, and respiratory and cardiovascular control mechanisms. Utilizing the enhanced ICSM simulation suite, a series of studies were conducted to examine various aspects of CPR strategies, all with the aim of improving resuscitation outcomes. These studies encompassed investigations into the impact of positive end-expiratory pressure (PEEP) on cardiac output during CPR, the effects of chest compression rate, depth, and duty cycle, the influence of the precipitating aetiology on CPR strategy optimization, and the comparison of personalized CPR strategies to current guidelines. The research also quantitatively identified the effect of CPR parameters on cardiac output, with end compression force and positive end expiratory pressure emerging as significant contributors. The validation of the ICSM simulation suite thoracic model using individual haemodynamic recordings of a patient undergoing CPR demonstrated its capacity to simulate individualized patient data for retrospective identification of optimized CPR protocols. These outcomes collectively emphasize the potential of computational models, particularly the ICSM simulation suite, to revolutionize CA and CPR research by providing humane, informative, and personalized alternatives to traditional animal models. The findings of this research suggest that the ICSM simulation suite offers a valuable alternative to animal models in the study of CA and CPR. This computational model allows for the simulation and investigation of personalized CPR strategies, which can be tailored to individual patients' need

Diffuse Optical Cerebral Diagnostics For Real-Time Guidance During Pediatric Surgery And Resuscitation

Adequate oxygen and blood flow are vital for the developing pediatric brain. Herein, we apply quantitative diffuse optical techniques, frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS), to non-invasively characterize cerebral oxygenation (StO2), blood flow (CBF), and oxygen metabolism (CMRO2) in pediatric animal models of hypoxic-ischemic injury. In a neonatal swine model (n=8) of congenital cardiac defect repair, we performed a two-part study which validated non-invasive diffuse optical measurements and uncovered significant limitations in the guidance of deep hypothermia using temperature during cardiopulmonary bypass. First, non-invasive CMRO2 was validated against invasive methods over wide temperature ranges (18-37C). Non-invasive measurements of CBF (p\u3c0.001) and CMRO2 (p\u3c0.001) were significantly associated with invasive measurements. Furthermore, a significant hysteresis (p=0.001) of cerebral metabolic temperature-dependence during cooling versus rewarming with respect to NPT is “fixed” with the use of ICT (p\u3e0.5). Second, we compared non-invasively measured cerebral metabolic parameters between cohorts who underwent deep hypothermia with or without circulatory arrest (DHCA; n=8). Cerebral metabolic temperature-dependence with respect to ICT in DHCA animals demonstrated significantly diminished temperature sensitivity during rewarming (p\u3c0.001; i.e., following reperfusion) compared to during cooling. Direct non-invasive CMRO2 measurement is an improved surrogate of cerebral status over temperature and enables individualized management of deep hypothermia and circulatory arrest. In another study of asphyxia-induced pediatric cardiac arrest and cardiopulmonary resuscitation (CPR), non-invasive measures of StO2, oxy-hemoglobin concentration ([HbO2]) and total hemoglobin concentration (THC) at 10-minutes of CPR were significantly associated with return of spontaneous circulation (ROSC). The absolute change in [HbO2] from 1-minute of CPR ([HbO2]CPR) was the optimal predictor of ROSC, with a mean (SD) AUC of 0.91 (0.07) across the first 10 minutes of CPR, evaluated at 1-minute intervals. Furthermore, separate high sensitivity and specificity threshold for ROSC were established. These results show, in several contexts, that non-invasive FD-DOS/DCS neuromonitoring provides unique physiological information about the developing pediatric brain that enables individualized identification of critical neurological risk periods and real-time guidance of clinical care

Can infant CPR performance be improved through the provision of 'real time' feedback?

Cardiac arrest (CA) is a significant health issue Worldwide. Paediatric sufferers have particu-larly poor outcomes, with high-rates of associated mortality and morbidity. Early cardiopulmonary-resuscitation (CPR), an emergency procedure which combines external chest-compressions with artificial-ventilations (rescue breaths), has been shown to improve CA outcomes. Researchers have, however, demonstrated CPR, even when delivered by highly-trained-rescuers is not currently being performed optimally. International guidelines have suggested the potential contribution of feedback systems (assistance), in improving the delivery of chest-compressions and rescue breaths to improve survival rates. Thus, the main focus of this research was to design and develop a real-time CPR-performance-feedback-system, to monitor and assist rescuers in producing high-quality infant-CPR (iCPR). This was conducted as follows: assessment of current compressions by Basic Life Support (BLS) and ‘lay’ rescuers, design and development of a real-time feedback and performance system and the study of its effects during iCPR. All performances were compared against benchmarked quality standards. During unassisted iCPR, BLS and ‘lay’ rescuer overall compression quality, that is those con-comitantly achieving all four iCPR quality targets, was 61.4% and >24.6%, respectively. Assistance delivered more breaths, 5-32%, more quickly, 30-84%, complying with recommendations. As-sisted compression count, after each ventilation, was 53% less than unassisted, complying with recommendations. There were no differences in the guideline compression duty cycle (DC), provided that compression time and peak depth were the same. Thesis summary iv Unassisted compressions failed to show compliance with quality targets. Assistance produced significant improvements in the overall quality of compressions, reduced the time for breaths and regulated the compression counts after each ventilation. However, lay rescuers require additional training with the feedback system and iCPR simulation. Overall the real-time feed-back system significantly improved iCPR performance, such that it could now be trialled to investigate possible improvements in clinical outcomes