The International Liaison Committee for Resuscitation-Review of the last 25 years and vision for the future

Peer reviewe

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland : a one-year retrospective study

Background: Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). Methods: The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. Results: The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86–3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). Conclusions: The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR

2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations : summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research

Machine Learning Techniques for the Detection of Shockable Rhythms in Automated External Defibrillators

Early recognition of ventricular fibrillation (VF) and electrical therapy are key for the survivalof out-of-hospital cardiac arrest (OHCA) patients treated with automated external defibrilla-tors (AED). AED algorithms for VF-detection are customarily assessed using Holter record-ings from public electrocardiogram (ECG) databases, which may be different from the ECGseen during OHCA events. This study evaluates VF-detection using data from both OHCApatients and public Holter recordings. ECG-segments of 4-s and 8-s duration were ana-lyzed. For each segment 30 features were computed and fed to state of the art machinelearning (ML) algorithms. ML-algorithms with built-in feature selection capabilities wereused to determine the optimal feature subsets for both databases. Patient-wise bootstraptechniques were used to evaluate algorithm performance in terms of sensitivity (Se), speci-ficity (Sp) and balanced error rate (BER). Performance was significantly better for publicdata with a mean Se of 96.6%, Sp of 98.8% and BER 2.2% compared to a mean Se of94.7%, Sp of 96.5% and BER 4.4% for OHCA data. OHCA data required two times morefeatures than the data from public databases for an accurate detection (6 vs 3). No signifi-cant differences in performance were found for different segment lengths, the BER differ-ences were below 0.5-points in all cases. Our results show that VF-detection is morechallenging for OHCA data than for data from public databases, and that accurate VF-detection is possible with segments as short as 4-s

Improved basic life support performance by ward nurses using the CAREvent (R) Public Access Resuscitator (PAR) in a simulated setting

Introduction: The CAREvent((R)) Public Access Resuscitator (PAR, O-Two Medical Technologies, Ontario, Canada) is a new oxygen-driven device alternating two ventilations with 15 prompts for chest compressions. The PAR is designed for use with a standard resuscitation face mask and is equipped with mask leakage and obstruction alarms. The purpose of this study was to assess the quality of basic life support (BLS) by hospital nurses and to evaluate if BLS with the PAR is better than BLS using the mouth-to-mask technique. Methods: The study group consisted of 352 nurses from Ghent University Hospital working outside the critical care and emergency departments. BLS skills were measured using a Laerdal Skillreporter manikin (Laerdal, Norway) connected to a Laerdal PC Skillreporting system. To assess base line skills, 200 nurses were tested without previous notice in single rescuer BLS using a pocket mask (PM, Laerdal, Norway) or a bag-valve mask device (Laerdal, Norway) over a period of 2 min. A separate consecutive sample of 152 nurses was randomised to the PM or PAR groups after a standard BLS refresher course. The PAR group received a short period of training in PAR use. Immediately after training,, both groups performed the 2 min single rescuer BLS test. Results: Unprepared nurses achieved only 26 compressions and 3 ventilations/min. Immediately after training, nurses using the PAR delivered 54 compressions/min as opposed to 35 for the PM group (p < 0.0001). PAR users ventilated six times/min compared to five times for PM users (p < 0.0001). Conclusion: Immediately after training, the use of the PAR improved BLS performance by ward nurses significantly, bringing the number of ventilations and compressions per minute close to the theoretical maximum achievable within the current guidelines. Retention tests after 6 and 12 months will show if the effect is sustained. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Retention of ventilation skills of emergency nurses after training with the SMART BAG (R) compared to a standard bag-valve-mask

Background and purpose: Studies show that nurses retain resuscitation skills poorly and that retention of ventilation skills is particularly difficult. We formed the hypothesis that the SMART BAG((R)) (SB, O-Two Medical Technologies Inc., Canada), i.e. a bag-valve-mask device with a pressure/flow responsive valve, would assist nurses in providing more efficient ventilation six months after training. Materials and methods: Prior to training, 39 emergency nurses performed CPR for 2 min, in pairs, using a standard bag-valve-mask device (STBVM, Laerdal, Norway) to assess their base tine skills. A CPR training manikin (Simulaids, USA) equipped with a PEEP valve in the oesophagus set at 20cm H2O was used to measure inspiratory time, tidal volume (Vt), peak pressure and gastric insufflation (Gl). Immediately following training they were tested using an O-Two STBVM and a SB. Half of the nurses were retested after three months, the other half after six months. Efficient ventilation was defined as a mean Vt > 400 ml and Gl < 50 ml in 1 min. Results: Before training, only 16% of nurses ventilated efficiently: 63% had Gl and 28% had Vt 400 ml, those without Gl had a lower peak pressure than those with Gl (7.8 cm H2O versus 17.7 cm H2O, p = 0.0001) and showed a trend towards a longer inspiratory time (1.28 s versus 1.08 s, p = 0.08). Of all efficient ventilations with a STBVM, 26% had a Vt > 600 ml. Conclusions: Six months after training, nurses ventilated at Least as efficiently with the SB, compared with the STBVM. This illustrates the ability of the SB to compensate for the deterioration over time in skill. On the other hand, training with a STBVM should focus primarily on prolonging the inspiratory time, and therefore the peak pressure, whilst maintaining an adequate Vt. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Policy statement: ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe.

The use of automated external defibrillators (AEDs) has a major impact in the management of cardiac arrest and substantial implications for public health. It is therefore important for the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC) to join forces to develop European recommendations for legislation on defibrillation, for training in AED use and for the development of AED community programmes. To fulfil these objectives a Policy Conference was organised jointly by ESC and ERC in December 2002 at the European Heart House in Sophia Antipolis, France. The present document is the result of that policy conference and it has four key objectives: to provide a critical appraisal of the studies published in the scientific literature on the use of AEDs. To present data on the status of legislation/organisation of defibrillation by non-medically qualified rescuers in Europe. To promote recommendations for the organisation of AED programmes in Europe that were collected and discussed during the policy conference. To identify the areas in which more research is needed before evidence based guidelines for the use of AEDs can be developed