Knowledge of the nurse in advanced life support and the impact of continuing education in cardiopulmonary arrest in the ICU

Objetivo: analisar as ocorrências, respostas e desfechos da parada cardiorrespiratória pré-hospitalar segundo o Utstein Style e identificar os fatores associados à sobrevida. Método: trata-se de um estudo quantitativo, documental e transversal, com vítimas de parada cardiorrespiratória atendidas nas unidades de suporte avançado de vida, no ano de 2015. Coletaram-se os dados a partir dos relatórios de atendimento do socorrista, organizando-os e analisando-os de acordo com o Utstein Style. Apresentaram-se os resultados em forma de tabelas. Resultados: verificaram-se 163 atendimentos, predominando o sexo masculino, não havendo associação entre idade e os desfechos. Identificou-se a maioria das PCRs como sendo de causa clínica, na residência e em assistolia, sendo entubação orotraqueal, acesso venoso periférico e administração de adrenalina os procedimentos mais frequentes. Constatou-se que as ocorrências presenciadas por espectadores leigos e o tempo-resposta da ambulância demonstraram uma associação com o desfecho sobrevida. Calculou-se a taxa de sobrevida em 25,1%. Conclusão: avaliou-se o serviço por meio da análise das ocorrências segundo o Utstein Style e verificaram-se associações entre o desfecho e as lacunas no atendimento, havendo a necessidade de intervenções em cada elo da corrente de sobrevivência. Descritores: Parada Cardíaca Extra-Hospitalar; Ressuscitação Cardiopulmonar; Serviços Médicos de Emergência; Ambulâncias; Emergências; Avaliação de Resultados. ABSTRACTObjective: to analyze the occurrences, responses and outcomes of prehospital cardiopulmonary arrest according to Utstein Style and to identify factors associated with survival. Method: this is a quantitative, documentary and cross-sectional study with victims of cardiopulmonary arrest treated at the advanced life support units in 2015. Data were collected from the rescuer's care reports and organized. and analyzing them according to Utstein Style. Results were presented in tables. Results: 163 cases were observed, predominantly male, with no association between age and outcomes. Most CRPs were identified as being of clinical cause, at home and in asystole, with orotracheal intubation, peripheral venous access and epinephrine administration being the most frequent procedures. It was found that the occurrences witnessed by lay spectators and the ambulance response time demonstrated an association with the survival outcome. The survival rate was calculated at 25.1%. Conclusion: the service was evaluated by analyzing the occurrences according to the Utstein Style and there were associations between the outcome and the gaps in care, requiring interventions in each link of the survival chain. Descriptors: Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Emergency Medical Services; Ambulances; Emergencies; Outcome Assessment. RESUMENObjetivo: analizar las ocurrencias, las respuestas y los resultados del paro cardiopulmonar prehospitalario según el Utstein Style e identificar los factores asociados con la supervivencia. Método: este es un estudio cuantitativo, documental y transversal con víctimas de paro cardiopulmonar tratadas en las unidades de soporte vital avanzado en 2015. Los datos se recopilaron de los informes de atención del rescatista, organizándolos y analizándolos según el Utstein Style. Los resultados se presentaron en tablas. Resultados: se observaron 163 casos, predominantemente masculinos, sin asociación entre la edad y los resultados. La mayoría de las PCRs se identificaron como de causa clínica, en el hogar y en la asistolia, siendo los procedimientos más frecuentes la intubación orotraqueal, el acceso venoso periférico y la administración de adrenalina los procedimientos más frecuentes. Se descubrió que las ocurrencias presenciadas por espectadores legos y el tiempo de respuesta de la ambulancia demostraron una asociación con el resultado de supervivencia. La tasa de supervivencia se calculó en 25.1%. Conclusión: el servicio se evaluó analizando las ocurrencias según el Utstein Style y hubo asociaciones entre el resultado y las brechas en la atención, lo que requiere intervenciones en cada eslabón de la cadena de supervivencia. Descriptores: Paro Cardíaco Extra-Hospitalario; Reanimación Cardiopulmonar; Servicios Médicos de Urgencia; Ambulancias, Urgencias Médicas, Evaluación de Resultado.

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Pediatric Resuscitation

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0008 ◽

2020 ◽

pp. 67-74

Author(s):

Matthew Mendes ◽

Taylor McCormick

Keyword(s):

Respiratory Failure ◽

Life Support ◽

Early Recognition ◽

Cardiopulmonary Arrest ◽

Advanced Life Support ◽

High Stakes ◽

Pediatric Resuscitation ◽

Critically Ill Child ◽

Equipment Sizing ◽

Equipment System

Respiratory failure is the most common cause of cardiopulmonary arrest in children. Early recognition of the critically ill child and aggressive management of respiratory failure and shock are crucial to preventing cardiopulmonary arrest. Although caring for a sick child can be highly stressful for emergency physicians, pediatric resuscitation largely mirrors that of adults, with special consideration of a few key anatomic and physiologic differences. It is important to have a systematic approach to patient assessment, medication dosing, and equipment sizing in order to cognitively offload the emergency provider. The following will help maximize performance in these high-stakes situations: the Pediatric Assessment Triangle combined with the familiar airway, breathing, circulation, disability, exposure approach; an age-, weight-, or length-based medication/equipment system; and routine application of Pediatric Advanced Life Support algorithms.

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Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece

Gastroenterology Research and Practice ◽

10.1155/2020/8701791 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Georgios Tziatzios ◽

Dimitrios N. Samonakis ◽

Theocharis Tsionis ◽

Spyridon Goulas ◽

Dimitrios Christodoulou ◽

...

Keyword(s):

Airway Management ◽

Public Hospital ◽

Private Hospital ◽

Life Support ◽

Advanced Life Support ◽

Nationwide Survey ◽

Web Based ◽

The Public ◽

Management Techniques ◽

The Impact

Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.

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Methodology of Specialist Physicians Training: From Traditional to e-Learning

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207681 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7681

Author(s):

Juan Chaves ◽

Antonio A. Lorca-Marín ◽

Emilio José Delgado-Algarra

Keyword(s):

Life Support ◽

Medical Training ◽

Advanced Life Support ◽

Sample Volume ◽

Mixed Methodology ◽

Face To Face ◽

Significant Difference ◽

The Face ◽

E Learning ◽

The Impact

Different studies show that mixed methodology can be effective in medical training. However, there are no conclusive studies in specialist training on advanced life support (ALS). The main objective of this research is to determine if, with mixed didactic methodology, which includes e-learning, similar results are produced to face-to-face training. The method used was quasi-experimental with a focus on efficiency and evaluation at seven months, in which 114 specialist doctors participated and where the analysis of the sociodemographic and pre-test variables points to the homogeneity of the groups. The intervention consisted of e-learning training plus face-to-face workshops versus standard. The results were the performance in knowledge and technical skills in cardiac arrest scenarios, the perceived quality, and the perception of the training. There were no significant differences in immediate or deferred performance. In the degree of satisfaction, a significant difference was obtained in favour of the face-to-face group. The perception in the training itself presented similar results. The main limitations consisted of sample volume, dropping out of the deferred tests, and not evaluating the transfer or the impact. Finally, mixed methodology including e-learning in ALS courses reduced the duration of the face-to-face sessions and allowed a similar performance.

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OPALS Pediatric Study: What Is the Impact of Advanced Life Support on out-of-hospital Cardiac Arrest?

Academic Emergency Medicine ◽

10.1197/j.aem.2005.03.039 ◽

2005 ◽

Vol 12 (Supplement 1) ◽

pp. 17-18

Author(s):

I. G. Stiell

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Pediatric Study ◽

The Impact ◽

Hospital Cardiac Arrest

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Investigation of health professionals’ knowledge retention in CPR after completing the Advance Life Support in Gynecology (ALSG) Course

10.21203/rs.3.rs-47957/v1 ◽

2020 ◽

Author(s):

Nikolaos Vrachnis ◽

Nikolaos Antonakopoulos ◽

Antigoni Tsigirlioti ◽

Vasilios Pergialiotis ◽

Nicoleta Iacovidou ◽

...

Keyword(s):

Health Professionals ◽

Life Support ◽

Cardiopulmonary Arrest ◽

Advanced Life Support ◽

Knowledge Retention ◽

Standards Of Care ◽

Time Interval ◽

Continuous Training ◽

Factors Affecting ◽

High Standards

Abstract Background Studies have shown that immediate and effective cardiopulmonary resuscitation plays a major role in the survival of victims of cardiac arrest. Numerous studies also demonstrate the need for continuous training of health professionals. In Greece life support courses are established in various fields including pediatrics, obstetrics and gynecology. The ALSG (Advanced Life Support in Gynecology) course was initiated in 2011 and covers gynecological emergencies that often lead to cardiopulmonary arrest, including ruptured ectopic pregnancy, toxic shock syndrome and postoperative collapse. The purpose of this study was to investigate knowledge retention in CPR after completion of the ALSG course and to define the factors affecting it. Methods A descriptive qualitative study was, designed and conducted through anonymous questionnaires sent electronically to past ALSG course participants. Results A total of 100 questionnaires were sent and 50 were completed and returned. Mean knowledge retention was 87.4 ± 18.2. The multivariate analysis revealed that the time interval since training in life support significantly correlated with the actual score. Additionally, more correct answers were given by course instructors than certified course graduates. Conclusion Instructors in life support courses achieve longer retention of their knowledge than trainees, while increased time interval between training and knowledge recall results in lower scores. In conclusion, continuing education of health professionals and adoption of algorithms, such as those taught in the ALSG course, are likely to help maintain knowledge and achieve high standards of care.

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PREPAREDNESS OF CANADIAN PHYSICIAN OFFICES FOR PAEDIATRIC EMERGENCIES

Paediatrics & Child Health ◽

10.1093/pch/pxy054.013 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e5-e5

Author(s):

Anushka Weeraratne ◽

Dayae Jeong ◽

Suhrata Verma ◽

Marina Atalla ◽

Mohammed Hassan-Ali ◽

...

Keyword(s):

Emergency Preparedness ◽

Life Support ◽

Advanced Life Support ◽

Family Physicians ◽

Care Staff ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Past ◽

Paediatric Emergency ◽

The Impact

Abstract BACKGROUND Studies in the US have demonstrated that many primary care staff and offices are inadequately prepared for paediatric emergencies. Although the Canadian Paediatric Society (CPS) recently reaffirmed their “Guidelines for Paediatric Emergency Equipment and Supplies for a Physician’s Office”, no evaluation has been made regarding the impact of publishing these recommendations, or on the state of preparedness for paediatric emergencies in family physician offices. OBJECTIVES The aim of this study was to evaluate awareness of and adherence of family physicians in Ontario to the CPS guidelines on preparedness for paediatric emergencies. DESIGN/METHODS We conducted a province-wide, cross-sectional survey of 749 randomly selected family physicians. Participants were asked to complete a 14-question survey regarding clinic characteristics, incidence of paediatric emergencies, and preparedness of the clinic in the case of a paediatric emergency. Ethics approval was obtained from the regional Ethics Review Board. RESULTS 94 physicians responded to our survey (response rate of 13.1%). 68.1% of respondents reported seeing more than 10 children per week, and 59.6% and had experienced at least one paediatric emergency in the past year. The proportion of physicians reporting paediatric emergencies within the last year increased with the number of children seen - 37.9% of physicians who saw fewer than 10 children per week reported an emergency, compared to 100.0% of those who saw more than 40 children per week. Only 4.3% respondents reported that they were unaware of the CPS guidelines on paediatric emergency preparedness. Although 85.1% of respondents were aware of the guidelines, only 10.6% of respondents had read them. Of the physicians who were aware of but had not read the guidelines, 2.5% engaged in mock code sessions, 27.8% were up-to-date on Paediatric Advanced Life Support (PALS), 1.3% had written protocols outlining safe transport of children to hospitals, and 41.8% stocked half or more of the recommended supplies. In comparison, of the physicians who had read the guidelines, 20.0% engaged in mock code sessions, 50.0% were up-to-date on PALS, 10.0% had written protocols, and 70.0% stocked half or more of the recommended supplies. CONCLUSION A large proportion of respondents had experienced at least one paediatric emergency in the past year, but were overall underprepared. There was a discrepancy between physicians who were aware of the CPS guidelines on emergency preparedness (85.1%), and those who have actually read them (10.6%), though offices with the latter were more adherent to the guidelines’ recommendations. It will be important for CPS to consider how to further advocate for paediatric emergency preparedness in clinics that see children regularly.

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Do radiologists want/need training in cardiopulmonary resuscitation?: Results of an internet questionnaire

Acta Radiologica ◽

10.1258/rsmacta.44.1.56 ◽

2003 ◽

Vol 44 (1) ◽

pp. 56-58

Author(s):

F. Schellhammer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Life Support ◽

Response Rate ◽

Cardiopulmonary Arrest ◽

Advanced Life Support ◽

Further Education ◽

German Speaking ◽

Life Threatening ◽

Training Courses ◽

E Mail

Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5±13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological departments themselves should organize courses in order to cope with their specific situations.

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Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1731787 ◽

2021 ◽

Author(s):

Nancy M. Tofil ◽

Stacy L. Gaither ◽

Charli Cohen ◽

Carrie Norwood ◽

Jerry Lynn Zinkan ◽

...

Keyword(s):

Life Support ◽

Cardiopulmonary Arrest ◽

Training Session ◽

Advanced Life Support ◽

Performance Score ◽

Performance Skills ◽

Score Following ◽

Resuscitation Training ◽

Significant Difference ◽

Key Events

AbstractPediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days–3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups (p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups (p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

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Abstract 19131: The Advanced Life Support Termination of Resuscitation Rule: A Local Evaluation of the Impact on Termination Rates

Circulation ◽

10.1161/circ.132.suppl_3.19131 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Joris Nas ◽

Judith L Bonnes ◽

Dominique V Verhaert ◽

Wessel Keuper ◽

Pierre van Grunsven ◽

...

Keyword(s):

Life Support ◽

Response Times ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Shock Delivery ◽

Bystander Cardiopulmonary Resuscitation ◽

Initial Rhythm ◽

Bystander Cpr ◽

The Impact ◽

Termination Decisions

Introduction: Termination of Resuscitation (TOR) rules have been designed to guide in-field termination decisions and reduce futile hospital transportations. The impact of such a rule may depend on regional infrastructure, arrest characteristics and pre-existent termination rates. Our region is characterized by high rates of bystander cardiopulmonary resuscitation (CPR), and Advanced Life Support (ALS) trained rescuers authorized to make termination decisions. We aim to investigate the actual in-field termination rates and the termination rates as recommended by the ALS-TOR rule. Furthermore, we studied factors associated with the actual termination decisions. Methods: Cohort of out-of-hospital cardiac arrest patients who were resuscitated in the Nijmegen area, the Netherlands (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Results: The observed percentage of in-field termination was 46% (275/598), while the ALS-TOR rule recommended termination in only 6% (35/588), owing to high percentages of witnessed arrests (73%) and bystander CPR (54%) in our region. Factors independently associated with the actual decisions to terminate resuscitation were absence of ROSC [aOR 35.6 (95% CI 18.3-69.3)], non-shockable initial rhythm [aOR 6.0 (95% CI 3.2-11.0)], unwitnessed arrest [aOR 2.7 (95% CI 1.4-5.2)], non-public arrest [aOR 2.5 (95% CI 1.2-5.0)] and longer EMS-response times [aOR 1.1 per minute increase (95% CI 1.0-1.2)]. Conclusions: Contrary to previous studies, implementation of the ALS-TOR rule in our region would have decreased termination rates from almost half to less than 10% due to the favourable arrest characteristics. In light of the prognosis after OHCA, this finding suggests that adherence to this set of criteria does not contribute to efficient triage in our population. Therefore it seems prudent to locally evaluate the utility of the ALS-TOR rule prior to implementation.

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