Analysis of the drowning risk associated with aquatic environment and swimming ability [Análisis del riesgo de ahogamiento asociado al entorno acuático y competencia natatoria]

A high level of swimming can be a protective factor against drowning, however, this relationship has not yet been empirically demonstrated, based on water competence level and aquatic environment. This study designed a drowning risk matrix based on the probabilistic analysis of a questionnaire answered by 3,181 participants. The occurrence of Aquatic Stress/Distress (ASD) was analysed based on 5 skill levels and three aquatic scenarios: a) Pool without waves or currents, b) Lakes, reservoirs, rivers and beaches without waves or currents, c) Rivers, beaches or pools with waves and/or currents. The results were expressed in Odds Ratio (OR). ASD risk exceeded OR of 25 in the most dangerous environment and increased for all scenarios as aquatic competency worsened. Three out of four swimmers have experienced an ASD and this event could have been an incentive to improve their water competence. © 2022, Universidad Autonoma de Madrid y CV Ciencias del Deporte. All rights reserved

Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study

Introduction: Drowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR.Methods: A quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway).Results: The quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques.Conclusion: The rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.Universidade de Vigo/CISU

Schoolteachers as candidates to be basic life support trainers: A simulation trial

Background: The aim was to assess future schoolteachers’ basic life support (BLS) knowledge and willingness to include this content in school lessons. The aim was also to determine the learning effect of a brief BLS hands-on training session, supported by real-time feedback. Methods: A convenience sample of 98 University students of Educational Sciences and Sports were recruited. The training program consisted of brief theoretical and hands-on interactive sessions with a 2/10 instructor/participants ratio. Knowledge and willingness was assessed by means of a survey. Chest compressions (CC) and ventilation quality were registered in 47 cases during 1 min cardiopulmonary resuscitation (CPR) tests. Results: Fifty-eight percent of subjects declared to know how to perform CPR, 62% knew the correct chest compression/ventilation ratio but only one in four knew the CC quality standards. Eighty-eight percent knew what an automated external defibrillator (AED) was; willingness to use the device improved from 70% to 98% after training. Almost half of CCs were performed atan adequate rate. Men performed deeper compressions than women (56.1 ± 4.03 mm vs. 52.17 ± 5.51 mm, p = 0.007), but in both cases the mean value was within recommendations. Full chest recoil was better in women (72.2 ± 32.8% vs. 45.4 ± 32.9%, p = 0.009). All CCs were delivered with correct hand positions. Conclusions: Brief hands-on training supported by real-time feedback of CPR quality helps future schoolteachers improve their knowledge, self-confidence and CPR skills. BLS training should be implemented in University curricula for schoolteachers in order to promote their engagement in effective BLS training of schoolchildren.S

Comparación de la calidad en la ventilación de socorristas nóveles y veteranos. Un estudio piloto de simulación.

Antecedentes: Los socorristas son fundamentales en la reanimación del ahogado en parada cardiorrespiratoria. En las víctimas ahogadas es prioritario administrar oxigenación. Distintas técnicas de administración de ventilaciones se han investigado y hay controversia sobre la más efectiva. Objetivos: comparar el efecto de la ventilación boca a boca (VBB), ventilación con bolsa y mascarilla (VBM) y ventilación con pocket-mask (VPM) sobre la calidad de RCP entre socorristas recién certificados y socorristas profesionales en activo. Método: 52 socorristas profesionales (14 recién certificados y 38 en activo sin formación en soporte vital básico (SVB) el último año). Cada socorrista realizó 3 test aleatorizados de RCP en un maniquí Resusci Anne conectado a Wireless SkillReporter (Laerdal Medical, Stavanger, Norway) variando la técnica de ventilación: VBB, VBM y VPM. La RCP fue de 4 minutos de duración, por parejas, con un cambio de roles a los 2 minutos, y con el protocolo de ahogados (iniciando por 5 ventilaciones). La calidad global de RCP fue calculada con la fórmula QCPR = (QCT + VVA)/2. Siendo QCT (calidad de posición de manos + ritmo + reexpansión torácica + profundidad) /4 y VVA las ventilaciones administradas con volumen adecuado (500-600ml). Resultados: Los participantes inexpertos recién certificados alcanzaron resultados mejores en todas las variables analizadas en comparación con los profesionales en activo. Esto incluye la calidad global de la RCP con VBB (50.918.41% vs. 35.4912.06%, p=0.002) y VPM (49.094.74% vs. 34.979.69%, p<0.001), así como la mayoría de las variables de calidad de las ventilaciones con las 3 técnicas: VBB, VBM y VPM. Conclusiones: Los socorristas inexpertos recién certificados realizan mejor RCP, incluyendo la ventilación, que los que no han recibido una formación reciente. Es clave la actualización del SVB frecuente en socorristas

Can a voice assistant help bystanders save lives? A feasibility pilot study chatbot in beta version to assist OHCA bystanders

Objective: Evaluating the usefulness of a chat bot as an assistant during CPR care by laypersons. Methods: Twenty-one university graduates and university students naive in basic life support participated in this quasi-experimental simulation pilot trial. A version beta chatbot was designed to guide potential bystanders who need help in caring for cardiac arrest victims. Through a Question-Answering (Q&A) flowchart, the chatbot uses Voice Recognition Techniques to transform the user's audio into text. After the transformation, it generates the answer to provide the necessary help through machine and deep learning algorithms. A simulation test with a Laerdal Little Anne manikin was performed. Participants initiated the chatbot, which guided them through the recognition of a cardiac arrest event. After recognizing the cardiac arrest, the chatbot indicated the start of chest compressions for 2 min. Evaluation of the cardiac arrest recognition sequence was done via a checklist and the quality of CPR was collected with the Laerdal Instructor App. Results: 91% of participants were able to perform the entire sequence correctly. All participants checked the safety of the scene and made sure to call 112. 62% place their hands on the correct compression point. A media time of 158 s (IQR: 146–189) was needed for the whole process. 33% of participants achieved high-quality CPR with a median of 60% in QCPR (IQR: 9–86). Compression depth had a median of 42 mm (IQR: 33–53) and compression rate had a median of 100 compressions/min (IQR: 97–100). Conclusion: The use of a voice assistant could be useful for people with no previous training to perform de out-of-hospital cardiac arrest recognition sequence. Chatbot was able to guide all participants to call 112 and to perform continuous chest compressions. The first version of the chatbot for potential bystanders naive in basic life support needs to be further developed to reduce response times and be more effective in giving feedback on chest compressionsS

Are smart glasses feasible for dispatch prehospital assistance during on-boat cardiac arrest? A pilot simulation study with fishermen.

The aim of the study was to explore feasibility of basic life support (BLS) guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve participants assisted a simulated out-of-hospital cardiac arrest on a fishing boat assisted by the dispatcher through the SGs. The SGs were connected to make video calls. Feasibility was assessed whether or not they needed help from the dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality (hands-only) during 2 consecutive minutes (1st minute without dispatcher feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed by comparing the assessment of variables performed by the dispatcher through SGs with those registered by an on-scene instructor. Assistance through SGs was needed in 72% of the BLS steps, which enabled all participants to perform the ABC approach and use AED correctly. Feasibility was proven that dispatcher's feedback through SGs helped to improve bystanders' performance, as after dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the analyzed skills: greatest difference in the "incorrect hand position during CPR" (on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd minute, there were only significant differences in the percentage of compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs in aquatic settings is feasible and improves BLS. CPR quality markers were similar with and without SG. These devices have great potential for communication between dispatchers and laypersons but need more development to be used in real emergencies

Quality of ventilations during infant resuscitation: a simulation study comparing endotracheal tube with face mask

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers

Longitudinal relationship of liver injury with inflammation biomarkers in COVID-19 hospitalized patients using a joint modeling approach

The mechanisms underlying liver disease in patients with COVID-19 are not entirely known. The aim is to investigate, by means of novel statistical techniques, the changes over time in the relationship between inflammation markers and liver damage markers in relation to survival in COVID-19. The study included 221 consecutive patients admitted to the hospital during the first COVID-19 wave in Spain. Generalized additive mixed models were used to investigate the influence of time and inflammation markers on liver damage markers in relation to survival. Joint modeling regression was used to evaluate the temporal correlations between inflammation markers (serum C-reactive protein [CRP], interleukin-6, plasma D-dimer, and blood lymphocyte count) and liver damage markers, after adjusting for age, sex, and therapy. The patients who died showed a significant elevation in serum aspartate transaminase (AST) and alkaline phosphatase levels over time. Conversely, a decrease in serum AST levels was observed in the survivors, who showed a negative correlation between inflammation markers and liver damage markers (CRP with serum AST, alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]; and D-dimer with AST and ALT) after a week of hospitalization. Conversely, most correlations were positive in the patients who died, except lymphocyte count, which was negatively correlated with AST, GGT, and alkaline phosphatase. These correlations were attenuated with age. The patients who died during COVID-19 infection displayed a significant elevation of liver damage markers, which is correlated with inflammation markers over time. These results are consistent with the role of systemic inflammation in liver damage during COVID-19S

Influence on Cardiopulmonary Resuscitation quality in the school environment: Study of various factors.

Las maniobras de Soporte Vital Básico y Reanimación Cardiopulmonar se realizan para evitar el fallecimiento en caso de parada cardiorrespiratoria. El conocimiento de la cadena de supervivencia y la calidad de las maniobras de Reanimación Cardiopulmonar tienen un aspecto importante en relación con las probabilidades de resucitación efectiva. Debido a esto, los factores que pueden condicionar la calidad de las maniobras de Reanimación Cardiopulmonar son normalmente analizados en estudios científicos. Algunos de estos factores que condicionan la calidad de la Reanimación Cardiopulmonar son la edad, el índice de masa corporal y el peso, la fatiga física, la formación recibida o la fuerza aplicada sobre el esternón. Por lo tanto, el objetivo de este plan de investigación es analizar la influencia de diferentes factores (características antropométricas, edad, formación recibida) en la calidad de las maniobras de Soporte Vital Básico y Reanimación Cardiopulmonar.As manobras de Soporte Vital Básico e Reanimación Cardiopulmonar realízanse para evitar o falecemento no caso de parada cardiorrespiratoria. O coñecemento da cadea de supervivencia e a calidade das manobras de Reanimación Cardiopulmonar supón un aspecto importante na relación coas probabilidades de resucitación efectiva. Debido a isto, os factores que poden condicionar a calidades das manobras de Reanimación Cardiopumonar son normalmente analizados en estudos científicos. Algúns destes factores que condicionan a calidade da Reanimación Cardiopulmonar son a idade, o índice de masa corporal e o peso, a fatiga física, a formación recibida ou a forza aplicada sobre o esterno. Polo tanto, o obxectivo deste plan de investigación é analizar a influencia de diferentes factores (características antropométricas, idade, formación recibida) na calidade das manobras de Soporte Vital Básico e Reanimación Cardiopulmonar.Basic Life Support and Cardiopulmonary Resuscitation manoeuvres are performed to prevent death in case of cardiac arrest. Chain of Survival knowledge and Cardiopulmonary Resuscitation quality have an important influence on probability of effective resuscitation. Because of this, the factors that can affect the CPR quality are normally analysed in scientific studies. Some of these factors are age, body mass index and weight, physical fatigue, training provided or force applied to the breastbone. Therefore, the aim of this research plan is analysing the influence of various factors (anthropometric characteristics, age, training provided) on Basic Life Support and Cardiopulmonary Resuscitation quality

Assessing ventilation skills by nursing students in paediatric and adult basic life support: A crossover randomized simulation study using Bag-Valve-Mask (BMV) vs Mouth-to-Mouth Ventilation (MMV)

To evaluate nursing students’ CPR skills using mouth-to-mouth (MMV) and bag-valve-mask (BMV) ventilation techniques on manikin simulators for infant and adult victims after practical and theoretical training. A quasi-experimental randomised cross-over design study with 44 nursing students was carried out. The participants attended a 5-hour theoretical and practical CPR training session using MMV and BMV on adult and infant manikins. A month later, four 4-minute CPR tests were performed in pairs. Two tests were performed on the infant manikin and two on the adult, using the two ventilation techniques (MMV and BMV). No significant differences between the tests were observed in the quality of chest compression (p > 0.008). Significantly higher values of effective ventilations were observed with MMV as compared with BMV in both age groups: Adult (MMV: 98 ± 7% / BMV: 84 ± 17% / p = 0.003) and Infant (MMV: 97 ± 11% / BMV: 76 ± 26% / p = 0.001). CPR quality was significantly higher when using MMV on the infant (68 ± 16%; p < 0.001) than in the other tests. The nursing students did not manage to master BMV with either victim. New complementary strategies to help them grasp the necessary BMV skills will be required