In a bed or on the floor? - The effect of realistic hospital resuscitation training: A randomised controlled trial.

INTRODUCTION: In-hospital cardiac arrest has a poor prognosis and often occurs in patients lying in a hospital bed. A bed mattress is a soft compressible surface that may decrease cardiopulmonary resuscitation (CPR) quality. Often hospital CPR training is performed with a manikin on the floor. AIM: To study CPR quality following realistic CPR training with a manikin in a bed compared with one on the floor. METHODS: We conducted a randomised controlled study. Healthcare professionals were randomised to CPR training with a manikin in a hospital bed or one on the floor. Data on CPR quality was collected from manikins. The primary outcome measure was chest compression depth. RESULTS: In total, 108 healthcare professionals (age: 40years, female: 94%) were included. The mean chest compression depth was 39mm (standard deviation (SD): 10), for the bed group compared with 38mm (SD: 9) for the floor group, p=0.49. A post hoc analysis showed that regardless of the training method, the participants who optimised their working position by jumping onto the bed or lowering the bed had a median chest compression depth of 39mm (25th-75th percentiles: 33-45) compared with 29mm (25th-75th percentiles: 23-41) for participants who did neither, p=0.04. CONCLUSION: There was no significant difference in chest compression depth between healthcare professionals who trained CPR on a manikin in a hospital bed compared with one on the floor. Chest compression depth was too shallow in both groups. Irrespective of the training method, participants who optimised their working position performed deeper chest compressions.

The Right Ventricle Is Dilated During Resuscitation From Cardiac Arrest Caused by Hypovolemia: A Porcine Ultrasound Study.

OBJECTIVES: Dilation of the right ventricle during cardiac arrest and resuscitation may be inherent to cardiac arrest rather than being associated with certain causes of arrest such as pulmonary embolism. This study aimed to compare right ventricle diameter during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, or primary arrhythmia (i.e., ventricular fibrillation). DESIGN: Thirty pigs were anesthetized and then randomized to cardiac arrest induced by three diffrent methods. Seven minutes of untreated arrest was followed by resuscitation. Cardiac ultrasonographic images were obtained during induction of cardiac arrest, untreated cardiac arrest, and resuscitation. The right ventricle diameter was measured. Primary endpoint was the right ventricular diameter at the third rhythm analysis. SETTING: University hospital animal laboratory. SUBJECTS: Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). INTERVENTIONS: Pigs were randomly assigned to cardiac arrest caused by either hypovolemia, hyperkalemia, or primary arrhythmia. MEASUREMENTS AND MAIN RESULTS: At the third rhythm analysis during resuscitation, the right ventricle diameter was 32 mm (95% CI, 29-35) in the hypovolemia group, 29 mm (95% CI, 26-32) in the hyperkalemia group, and 25 mm (95% CI, 22-28) in the primary arrhythmia group. This was larger than baseline for all groups (p = 0.03). When comparing groups at the third rhythm analysis, the right ventricle was larger for hypovolemia than for primary arrhythmia (p < 0.001). CONCLUSIONS: The right ventricle was dilated during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, and primary arrhythmia. These findings indicate that right ventricle dilation may be inherent to cardiac arrest, rather than being associated with certain causes of arrest. This contradicts a widespread clinical assumption that in hypovolemic cardiac arrest, the ventricles are collapsed rather than dilated.

Differences in implementation strategies of the European Resuscitation Council Guidelines 2015 in Danish hospitals - a nationwide study.

INTRODUCTION: Guideline implementation is essential to improve survival following cardiac arrest. This study aimed to investigate awareness, expected time frame, and strategy for implementation of the European Resuscitation Council (ERC) Guidelines 2015 in Danish hospitals. METHODS: All public, somatic hospitals with a cardiac arrest team in Denmark were included. A questionnaire was sent to hospital resuscitation committees one week after guideline publication. The questionnaire included questions on awareness of ERC Guidelines 2015 and time frame and strategy for implementation. RESULTS: In total, 41 hospitals replied (response rate: 87%) between October 22 and December 22, 2015. Overall, 37% hospital resuscitation committees (n=15) were unaware of the guideline content. Most hospitals (80%, n=33) expected completion of guideline implementation within 6 months and 93% hospitals (n=38) expected the staff to act according to the ERC Guidelines 2015 within 6 months. In contrast, 78% hospitals (n=32) expected it would take between 6 months to 3 years for all staff to have completed a resuscitation course based on ERC Guidelines 2015. Overall, 29% hospitals (n=12) planned to have a strategy for implementation later than a month after guideline publication and 10% (n=4) hospitals did not plan to make a strategy. CONCLUSION: There are major differences in guideline implementation strategies among Danish hospitals. Many hospital resuscitation committees were unaware of guideline content. Most hospitals expected hospital staff to follow ERC Guidelines 2015 within six months after the publication even though they did not offer information or skill training to all staff members within that time frame.

A low end-tidal CO2/arterial CO2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism.

INTRODUCTION: Identifying reversible causes of cardiac arrest is challenging. The diagnosis of pulmonary embolism is often missed. Pulmonary embolism increases alveolar dead space resulting in low end-tidal CO2 (EtCO2) relative to arterial CO2 (PaCO2) tension. Thus, a low EtCO2/PaCO2 ratio during resuscitation may be a sign of pulmonary embolism. METHODS: Post hoc analysis of data from two porcine studies comparing ultrasonographic measurements of right ventricular diameter during resuscitation from cardiac arrest of different causes. Pigs were grouped according to cause of arrest (pulmonary embolism, hypovolemia, primary arrhythmia, hypoxia, or hyperkalaemia) and EtCO2/PaCO2 ratios were compared. RESULTS: Data from 54 pigs were analysed. EtCO2 levels at the third rhythm analysis were significantly lower when cardiac arrest was caused by pulmonary embolism than by primary arrhythmia, hypoxia and hyperkalaemia, but there was no significant difference between pulmonary embolism and hypovolemia. In contrast, PaCO2 levels were higher in cardiac arrest caused by pulmonary embolism than in the other causes of cardiac arrest. Consequently, the EtCO2/PaCO2 ratio was lower in pulmonary embolism 0.2 (95%CI 0.1-0.4), than in hypovolaemia 0.5 (95%CI 0.3-0.6), primary arrhythmia 0.7 (95%CI 0.7-0.8), hypoxia 0.5 (95%CI 0.4-0.6), and hyperkalaemia 0.6 (95%CI 0.6-0.7). CONCLUSION: A low EtCO2/PaCO2 ratio during cardiopulmonary resuscitation suggests pulmonary embolism.