Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than ...specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.
Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation.
To compare ...breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing.
Schoolchildren aged 10–12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place.
192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001; OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001; OR = 21.094), (p = 0.002; OR = 4.553).
The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.
Abstract Background Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate ...has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. Aim To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. Methods Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. Result In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p = 0.006 (OR 6.571) detected breathing arrest within 2 min. Conclusion The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used.
...the level of consciousness could be maintained for a short period of time, which contradicts the current guidelines.Statement of the problem Over the last twenty years the Advanced Life Support ...Emergency Medical team FPUS 061 from Lugo (population 97,995), headed by a physician, have reported 2 cases of witnessed VF in conscious patients, respectively 68 and 85years of age. In July 2017, a survey was e-mailed to all Advanced Life Support (ALS) providers in the EMS 061-Galicia (Spain) inquiring if at any time during their professional career they had ever assessed a victim as responsive (completely conscious) and normally breathing with the ECG rhythm on the monitor changing from an organized rhythm to a VF. 15 out of 22 (53%) practitioners (10 physicians and 5 nurses) answered positively, reporting a total of over 30 cases. Initially, this unique situation led to diagnostical doubts, the patients were responsive enough to deter resuscitation. 2 cases were initially interpreted as polymorphic ventricular tachycardia (torsades de pointes), but they were pulseless.
To the Editor, Current guidelines on resuscitation 1 endorse sending for an automated external defibrillator (AED) in unconscious victims not breathing normally, but in the first minutes of a ...witnessed cardiac arrest, breathing assessment could be challenging: in June of 2017 an off-duty physician witnessed a sudden episode of seizure at a sports centre equipped with a public access automated external defibrillator, and assessed the victim as unresponsive but breathing normally. According to video-based studies the sensitivity for observers correctly distinguishing normal from abnormal breathing was 60% 2, reaching 90% 3 after training in medical students, but in the first minute of a witnessed cardiac arrest, breathing movements might remain normal, 4 deteriorating progressively without a clear limit between normal and abnormal, making the assessment difficult, increasing the risk of delaying the defibrillation of VF. According to a human simulation study 5, although all participants recognized the victims´ unconsciousness in the first assessment, only 4 out of 59 participants identified the breathing as abnormal, and even after 2 min of apnea 18 out of 59 participants were not able to recognize the breathing cessation.
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