Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger
George LatsiosMarianna LeopoulouΑndreas SynetosΑντώνιος ΚαρανάσοςAngelos PapanikolaouPavlos BounasEvangelia StamatopoulouKonstantinos TοutouzasKostas Tsioufis
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Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, "hands-on", rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially "hazardous" victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these "hostile" and dangerous settings, while comparing them to manual compressions.[Cardiopulmonary resuscitation skills. A survey among health and rescue personnel outside hospital].
The aim of this study was to survey practical skills and theoretical knowledge in lifesaving first aid among health and rescue workers outside hospital. 45 police officers, 46 firemen, 57 nurses and 42 general practitioners participated. Unprepared, they were presented with a "patient" (resuscitation doll) without respiration or heart beat, and were asked to do what was necessary to revive the "patient". They were afterwards questioned about specific emergency medical situations, how they assessed their own achievement and when they last had training in cardiopulmonary resuscitation. Only 1% were able to perform satisfactory basic cardiopulmonary resuscitation of a cardiac arrest according to the accepted guidelines, and only 17% ventilated and compressed efficiently with a rhythm of 2:15 or 1:5. 50% believed they were efficient in lifesaving first aid. Those who had taken a course in first aid during the previous year achieved significantly better results than the rest. It is concluded that health and rescue workers outside hospital follow the European Resuscitation Council's guidelines for basic cardiopulmonary resuscitation to only a small degree, but that the situation can be improved by more regular training.
First aid
Advanced Life Support
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The majority of attempts to resuscitate victims of prehospital cardiopulmonary arrest are unsuccessful, and patients are frequently transported to the emergency department for further resuscitation efforts. We evaluated the efficacy and costs of continued hospital resuscitation for patients in whom resuscitation efforts outside the hospital have failed. We reviewed the records of 185 patients presenting to our emergency department after an initially unsuccessful, but ongoing, resuscitation for a prehospital arrest (cardiac, respiratory, or both) by an emergency medical team. Prehospital and hospital characteristics of treatment for the arrest were identified, and the patients' outcomes in the emergency room were ascertained. The hospital course and the hospital costs for the patients who were revived were determined. Over a 19-month period, only 16 of the 185 patients (9 percent) were successfully resuscitated in the emergency department and admitted to the hospital. A shorter duration of prehospital resuscitation was the only characteristic of the resuscitation associated with an improved outcome in the emergency department. No patient survived until hospital discharge, and all but one were comatose throughout hospitalization. The mean stay in the hospital was 12.6 days (range, 1 to 132), with an average of 2.3 days (range, 1 to 11) in an intensive care unit. The total hospital cost for the 16 patients admitted was $180,908 (range per patient, $1,984 to $95,144). In general, continued resuscitation efforts in the emergency department for victims of cardiopulmonary arrest in whom prehospital resuscitation has failed are not worthwhile, and they consume precious institutional and economic resources without gain.
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Since the introduction of the modern techniques for cardiopulmonary resuscitation in the 1960s, professionals have discussed the need to standardize its application and teaching both among health care professionals and the general public. The "ILCOR", Committee to Coordinate Resuscitation Techniques, in an effort to simplify resuscitation techniques, set out some recommendations in August 2000 which were adopted by the leading organizations such as AHA and ERC, in charge of diffusing Vital Suport techniques. In these, different levels of attention have been incorporated depending on the qualifications which the person has who is provide this treatment. The most important changes are the necessity to put Emergency Medical Services into action rapidly; the techniques to follow if there are one or two persons apply resuscitation techniques; for artificial resuscition emergency care, new volumes depending on the use or non-use of oxygen; the acceptance of devices to open up alternate air passageways; recommendations whether or not it is pertinent to check on a patient's pulse depending on the qualifications of the person attending that patient; heart message techniques exterpulmonary resuscition woth only thorax compression and automatic external defibrillation.
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To the Editor.—
Recently,The Journalpublished "Standards for Cardiopulmonary Resuscitation and (CPR) Emergency Cardiac Care (ECC)" (227:833, 1974). Several practical points, often omitted in professional training, need emphasis. Effective CPR requires group organization. Resuscitation teaching usually consists of lectures and of practice in ventilating and compressing a dummy. Seldom is a "cardiac arrest" simulated; trainees must learn organization and performance techniques at real arrests. Efficiently delivered resuscitation, however, is as important as scientific knowledge. Group practices and preorganization are helpful. Since resuscitation of an arrested patient is perhaps the most dramatic scene in medicine, many hospital personnel are attracted to the scene. Most want to help, but after six to ten people arrive, additional people decrease efficiency. Resuscitation team members should include an anesthesiologist, a cardiologist, a pharmacist, and three or four others to bring equipment, compress the chest, start an intravenous infusion, inject drugs, and record events, butCardiac Resuscitation
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To the Editor.—
Recently,The Journalpublished "Standards for Cardiopulmonary Resuscitation and (CPR) Emergency Cardiac Care (ECC)" (227:833, 1974). Several practical points, often omitted in professional training, need emphasis. Effective CPR requires group organization. Resuscitation teaching usually consists of lectures and of practice in ventilating and compressing a dummy. Seldom is a "cardiac arrest" simulated; trainees must learn organization and performance techniques at real arrests. Efficiently delivered resuscitation, however, is as important as scientific knowledge. Group practices and preorganization are helpful. Since resuscitation of an arrested patient is perhaps the most dramatic scene in medicine, many hospital personnel are attracted to the scene. Most want to help, but after six to ten people arrive, additional people decrease efficiency. Resuscitation team members should include an anesthesiologist, a cardiologist, a pharmacist, and three or four others to bring equipment, compress the chest, start an intravenous infusion, inject drugs, and record events, butCardiac Resuscitation
Patient Care
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Abstract Background There are wide variations in survival after cardiopulmonary resuscitation. The aim of this survey was to describe how equipment provision of resuscitation trolleys was deployed in a range of clinical ward areas. Methods The equipment in randomly selected resuscitation trolleys in all 14 South West Thames Region hospitals was surveyed. The gold standard for equipment provision was referenced from the document CPR Guidance for Clinical Practice and Training in Hospital. Results There were significant differences in the provision of circulation equipment (p = 0.004) and in the rates of drug items present (p = 0.001). There was no significant difference in provision of airways equipment (p = 0.24) or immediate access items (p = 0.55). Conclusions There are variations in the provision of resuscitation equipment in many clinical areas. Hospitals need to review the procedures for ensuring adequate provision of resuscitation equipment in all clinical areas.
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Nurses have many roles and responsibilities in relation to cardiopulmonary resuscitation (CPR), including: recognising that a patient is deteriorating; recognising cardiac arrest and commencing CPR while waiting for the resuscitation team to arrive; ensuring the contents of the resuscitation trolley are present, in date and in full working order; and completing documentation for the National Cardiac Arrest Audit in participating healthcare organisations. Many patient safety incidents involving resuscitation trolley equipment and resuscitation have been reported, and predominantly relate to a lack of equipment, missing equipment and inadequately stocked trolleys. This article provides an overview of the contents of the standard resuscitation trolley and a rationale for the use of each item. It discusses the importance of checking and restocking the resuscitation trolley, as well as the documentation of CPR efforts.
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Nowadays, cardiopulmonary resuscitation is not routinely discussed with all hospital patients, even though it should be for a number of reasons. First of all, every patient may suffer cardiac arrest, and the overall outcome of a subsequent attempt at resuscitation is difficult to predict. Besides, patients who do not wish to be resuscitated often do not tell that to the physician of their own accord. Patients should therefore be more actively informed and encouraged to express their own preferences. The routine discussion of possible resuscitation gives physicians the opportunity to discuss, determine and delimit the extent of the intended medical procedure. In the literature, communication problems in three different areas can be identified as a cause of the present situation. These are--for both physician and patient--inability, lack of insight and unwillingness to discuss resuscitation. Physicians should be aware of the identified communication problems and deal with them in a professional manner. An understanding of these problems forms the basis for a broader implementation of resuscitation discussions in hospitals.
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