An expert consensus–based checklist for quality appraisal of educational resources on adult basic life support: a Delphi study

Objective: Given the lack of a unified tool for appraising the quality of educational resources for lay-rescuer delivery of adult basic life support (BLS), this study aimed to develop an appropriate evaluation checklist based on a consensus of international experts. Methods: In a two-round Delphi study, participating experts completed questionnaires to rate each item of a predeveloped 72-item checklist indicating agreement that an item should be utilized to evaluate the conformance of an adult BLS educational resource with resuscitation guidelines. Consensus on item inclusion was defined as a rating of ≥7 points from ≥75% of experts. Experts were encouraged to add anonymous suggestions for modifying or adding new items. Results: Of the 46 participants, 42 (91.3%) completed the first round (representatives of 25 countries with a median of 16 years of professional experience in resuscitation) and 40 (87.0%) completed the second round. Thirteen of 72 baseline items were excluded, 55 were included unchanged, four were included after modification, and four new items were added. The final checklist comprises 63 items under the subsections “safety” (one item), “recognition” (nine items), “call for help” (four items), “chest compressions” (12 items), “rescue breathing” (12 items), “defibrillation” (nine items), “continuation of CPR” (two items), “choking” (10 items) and “miscellaneous” (four items). Conclusion: The produced checklist is a ready-to-use expert consensus–based tool for appraising the quality of educational content on lay-rescuer provision of adult BLS. The checklist gives content developers a tool to ensure educational resources comply with current resuscitation knowledge, and may serve as a component of a prospective standardized international framework for quality assurance in resuscitation education

1028-63 Cardiac Troponin T as a Marker for Perioperative Myocardial Ischemia in Noncardiac Surgical Patients

Episodes of perioperative myocardial ischemia (PMI) occur in 18 to 74% of noncardiac surgical patients with or at risk for coronary artery disease (CAD). PMls correlate with adverse postoperative cardiac outcome. To determine the diagnostic value of cardiac troponin T(TnT) in PMI, we studied 28 patients (63.9±8.9 years) undergoing peripheral vascular surgery (n=16) or carotid endarterectomy (n=12). Patients included had either documented CAD (n=16) or two (n=7) or more (n=5) risk factors (age >65 years, smoking. diabetes mellitus. hypertension, or hypercholesterolemia >240 mg/dL). Patients with uninterpretable ECG for PMI were excluded. 12-lead ECG recordings and blood sampling for measurement of CK-MB activity and TnT levels (ELISA troponin 1. Boehringer Mannheim, Germany) were carried out preoperatively, and immediately, 20 h, 48 h, 72 h, and 84 h postoperatively. ECG recordings were analysed by an independent blinded cardiologist for signs of PMI (new ST segment depression >0.1 mV 60 ms after the J point, new T inversion). We found an overall incidence of ECG documented PMI of 54% (n=15), 93% occuring immediately postoperatively. Patients undergoing peripheral vascular surgery developed significantly less PMI than carotid surgical patients (38% vs. 75%; p<0.05, Fisher's Exact test). TnT levels >0.1 μg/L were found in 80% (n=12) of patients with PMI (ECG). Only one patient without ECG-documented PMI had TnT levels >0.1 μg/L. Thus, comparing a TnT cut off level of 0.1 μg/L with intermittent 12-lead ECG recording, we found a sensitivity of 80% and a specifity of 92%. We were unable to detect elevated levels of CK-MB in any patient (tab.).overall (n=28)per. vase. surg. (n=16)carotid surg. (n=12)CK-MB >6 U/L000ECG(PMI)15(54%)6 (38%)9(75%)TnT >0.1 μg/L13(46%)5(31%)8(67%)ConclusionIn contrast to CK-MB, TnT is a specific and sensitive marker of PMI in patients with or at risk for CAD undergoing noncardiac surgery

'Kids save lives': why schoolchildren should train in cardiopulmonary resuscitation

PURPOSE OF REVIEW Quick initiation of basic life support (BLS) by laypersons is one of the most successful strategies in the fight against sudden cardiac death. In developed countries, cardiac arrest is still a major contributor to avoidable death, and despite the fact that more than 50% of all cardiac arrests are witnessed, layperson BLS is performed in less than 20%. To improve this situation, BLS training in schools has been established. RECENT FINDINGS Cardiopulmonary resuscitation (CPR) instruction including the use of automatic external defibrillators (AEDs) has shown to be feasible even for young schoolchildren, and there is an indication that respective programmes are effective to enhance patient outcome on a population basis. Earlier training may even lead to more sustainable results; however, it is reasonable to implement adjusted curricula for different child ages. The programme 'Kids Save Lives' recently endorsed by the WHO will help promoting school-based BLS training worldwide demanding education on CPR for all pupils starting at least at age 12. SUMMARY Resuscitation training in schools can help to increase the amount of BLS-trained population. Social skills of pupils can be improved and training can be successfully implemented independently of the pupils' age and physique

Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP).Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures.Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38–45) vs. 45 (40–50) vs. 51 (50–52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102–131) compressions per minute (CPM) for manual CC, 107 (105–127) CPM for CPRMeter, and 102 (101–102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM — 100% (95–100), 80% (60–90) in CPRMeter group, and the lowest for manual CC — 29% (26–48).Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP

The lack of knowledge on acute stroke in Brazil: A cross-sectional study with children, adolescents, and adults from public schools

Objective: Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases and treatable as long as patients recognize it and reach capable medical facilities in time. This community-based study investigated students' stroke knowledge, Emergency Medical Services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels in the KIDS SAVE LIVES BRAZIL project. Methods: The authors conducted the survey with a structured questionnaire in 2019‒2020. Results: Students from the elementary-school (n = 1187, ∼13 y.o., prior experience: 14%, 51% women), high-school (n = 806, ∼17 y.o., prior experience: 13%, 47% women) and University (n = 1961, ∼22 y.o., prior experience: 9%, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42%‒66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62%‒65% of students recognized arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS number; 81% wanted to have stroke education at school, and ∼75% wanted it mandatory. Women, higher education, and prior experience were associated with higher scores of knowing risk factors (OR = 1.28, 95% CI: 1.10‒1.48; OR = 2.12, 95% CI: 1.87‒2.40; OR = 1.46, 95% CI: 1.16‒1.83; respectively), and warning signs- symptoms (OR = 2.22, 95% CI: 1.89‒2.60; OR = 3.30, 95% CI: 2.81‒3.87; OR = 2.04, 95% CI: 1.58‒2.63; respectively). Conclusion: Having higher education, prior experience, and being a woman increases stroke-associated risk factors, and warning signs and symptoms identification. Schoolchildren and adolescents should be the main target population for stroke awareness

Recommendations on the structure, personal, and organization of intensive care units

Background: Intensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system. Objectives: To provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. Design and setting: Development of recommendations based on a systematic literature search and a formal consensus process from a group of multidisciplinary and multiprofessional specialists from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). The grading of the recommendation follows the report from an American College of Chest Physicians Task Force. Results: The recommendations cover the fields of a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, qualitative and quantitative requirements of physicians and nurses as well as staffing with physiotherapists, pharmacists, psychologists, palliative medicine and other specialists, all adapted to the 3 levels of ICUs. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied. Conclusion: This document provides a detailed framework for organizing and planning the operation and construction/renovation of ICUs