The recovery position for maintenance of adequate ventilation and the prevention of cardiac arrest: A systematic review.

Aim: To conduct a systematic review of the use of the recovery position in adults and children with non-traumatic decreased levels of responsiveness changes outcomes in comparison with other positioning strategies. Methods: We searched Medline (Ovid), Embase, Cochrane Library, CINAHL, medRxiv and Google Scholar from inception to 15 March 2021 for studies involving adults and children in an out-of-hospital, first aid setting who had reduced levels of responsiveness of non-traumatic aetiology but did not require resuscitative interventions. We used the ROBINS-I tool to assess risk of bias and GRADE methodology to determine the certainty of evidence. Results: Of 17,947 citations retrieved, three prospective observational studies and four case series were included. The prone and semi-recumbent positions were associated with a decreased rate of suspected aspiration pneumonia in acute poisoning. Use of the recovery position in paediatric patients with decreased levels of responsiveness was associated with a deceased admission rate and the prone position was the position most commonly associated with sudden unexpected death in epilepsy. High risk of bias, imprecision and indirectness of evidence limited our ability to perform pooled analyses. Conclusion: We identified a limited number of observational studies and case series comparing outcomes following use of the recovery position with outcomes when other patient positions were used. There was limited evidence to support or revise existing first aid guidance; however, greater emphasis on the initial assessment of responsiveness and need for CPR, as well as the detection and management of patient deterioration of a person identified with decreased responsiveness, is recommended.

European Resuscitation Council Guidelines 2021: First aid.

The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.

Data concerning the Copenhagen tool: A research tool for evaluation of basic life Support educational interventions.

The data presented in this article are supplementary data related to the research article entitled "The Copenhagen Tool: A research tool for evaluation of BLS educational interventions" (Jensen et al., 2019). We present the following supplementary materials and data: 1) a standardized scenario used to introduce the test for gathering data on internal structure and additional response process; 2) test sheets used for rating test participant via video recordings; 3) interview-guide for collecting additional response process data; 4) items deemed relevant but not essential for laypersons, first responders and health personnel in the modified Delphi consensus process; 5) inter-rater reliability values for raters using the essential items of the tool to evaluate test participants via video recordings; 6) main themes from coding interviews with raters; 7) comparison of rater results and manikin software output.

The Copenhagen Tool a research tool for evaluation of basic life support educational interventions.

INTRODUCTION: Over the past decades, major changes have been made in basic life support (BLS) guidelines and manikin technology. The aim of this study was to develop a BLS evaluation tool based on international expert consensus and contemporary validation to enable more valid comparison of research on BLS educational interventions. METHODS: A modern method for collecting validation evidence based on Messick's framework was used. The framework consists of five domains of evidence: content, response process, internal structure, relations with other variables, and consequences. The research tool was developed by collecting content evidence based on international consensus from an expert panel; a modified Delphi process decided items essential for the tool. Agreement was defined as identical ratings by 70% of the experts. RESULTS: The expert panel established consensus on a three-levelled score depending on expected response level: laypersons, first responders, and health care personnel. Three Delphi rounds with 13 experts resulted in 16 "essential" items for laypersons, 21 for first responders, and 22 for health care personnel. This, together with a checklist for planning and reporting educational interventional studies within BLS, serves as an example to be used for researchers. CONCLUSIONS: An expert panel agreed on a three-levelled score to assess BLS skills and the included items. Expert panel consensus concluded that the tool serves its purpose and can act to guide improved research comparison on BLS educational interventions.

2020 International Consensus on First Aid Science With Treatment Recommendations.

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

A web-based micro-simulation program for self-learning BLS skills and the use of an AED. Can laypeople train themselves without a manikin?

AIM: Various methods, including self-instruction, have been used to try to improve the acquisition of basic life support skills. This is a preliminary report of the effectiveness of a web-based self-training program for BLS and the use of an AED. METHODS: Sixteen volunteers completed on-line training in their own time over a period of 8 weeks. The program included theory, scenario training and self-testing, but without practice on a manikin, or any instructor input. The volunteers were assessed, without prior warning, in a scenario setting. A recording manikin, expert assessors and video recording were used with a modified version of the Cardiff Test. RESULTS: All 16 volunteers performed the assessed skills in the use of an AED correctly. Most of the skills of BLS assessed were performed well. Chest compression depth and rate were performed less well (59% and 67% of participants, respectively, performed correctly). Opening the airway and lung inflation were performed poorly (38% and 13% of participants performed correctly), as was checking for safety (19% participants performed correctly). There was no significant correlation between the time a participant spent on-line and the quality of performance. Only 5 of the volunteers had ever attended a BLS course or used a resuscitation manikin before the assessment; their performance scores were not significantly better than those of the other 11 volunteers. CONCLUSION: These results suggest that it may be possible to train people in BLS and AED skills using a micro-simulation web-based interactive program but without any practice on a manikin. This seems to be particularly the case for the use of an AED, where performance achieved a uniformly high standard.

A preliminary feasibility study of a short DVD-based distance-learning package for basic life support.

OBJECTIVE: To test the hypothesis that laypeople who learn CPR using an 8-min self-instructional DVD acquire a level of skill that is comparable to that achieved with conventional courses. METHODS: Forty volunteers used a short DVD with replay facility, and a simple inflatable training manikin, for self-instruction in basic life support. A further 40 volunteers (control group) attended a conventional 1-h instructor-led course. Skill acquisition was measured for each group. RESULTS: After training, the self-instructional group achieved remarkably similar results compared with the control group for all measured skill variables except compression depth, which was significantly greater for the control group. CONCLUSION: Very short, DVD-based, self-instructional packages may be suitable for more widespread use, including distance-learning and other circumstances in which educational opportunities and resources are limited.

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.

2015 Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation: An ILCOR Advisory Statement.

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.

A reference basic life support provider course for Europe.

BACKGROUND: Good scientific evidence is scarce in relation to the effectiveness of different methods of teaching basic life support (BLS) to the general public. In order to test new courses or methods a reference course is needed as a comparative standard. OBJECTIVE: To propose a reference BLS provider course that can be used as a comparator when testing new courses or teaching methods. METHODS: All national resuscitation councils that are represented in the European Resuscitation Council (ERC) were sent a questionnaire about the BLS provider courses run by them or under their auspices. RESULTS: Sixteen national resuscitation councils responded to the enquiry. Their responses regarding organisation, structure, content and methods of the courses were found to be remarkably consistent between European countries. Few issues had a high variance. CONCLUSIONS: Based on the responses received, a reference BLS provider course for lay persons is suggested as a tool for research. The course duration is 3 h 15 min (excluding breaks), with 2 h 15 min practice time for the participants, 30 min for theory and 20 min for practical demonstrations by the instructor. A manual is distributed at the start of the course. The ratio of instructors to participants is one to six. The lectures are interactive between the instructor and the participants. Cardiopulmonary resuscitation (CPR) is practised on manikins in groups of six. A formal BLS scenario test may be held at the end of the course as part of a research study or if the candidates so request. It is suggested that by using this reference course during research into lay person BLS teaching, it will be easier to make comparisons between different studies.

A reference automated external defibrillator provider course for Europe.

BACKGROUND: Scientific evidence is scarce in relation to the effectiveness of different methods of teaching automated external defibrillator (AED) use to laypeople. A reference course is needed in order to test new courses or methods against a comparative standard. OBJECTIVE: To propose a reference AED provider course that can be used as a comparator when testing new courses or teaching methods. METHODS: All national resuscitation councils that are represented in the European Resuscitation Council were sent a questionnaire about the AED provider courses run by them or under their auspices. RESULTS: Sixteen national resuscitation councils responded to the enquiry. Apart from the individual course timetables, there was remarkable consistency amongst the European countries as regards organisation, structure, content and methods. CONCLUSIONS: A reference AED provider course for laypeople, based on a synthesis of existing European courses, is suggested as a tool for research. Prior completion of a basic life support provider course is mandatory. Course duration is 2 h 45 min (excluding breaks), with 1 h 40 min practice time for the participants, 25 min for theory, 20 min for practical demonstrations by the instructor and 20 min for introduction, discussion and closure. A manual is distributed at the start of the course. The ratio of instructors to participants is one to six. Lectures are interactive between the instructor and the class. AED use is practised in groups of six participants. Participants prove their competency by means of a formal test that simulates a cardiac arrest scenario. Using this course as a comparator during research into the methodology of AED teaching would provide a reference against which other courses could be tested.

Teaching hand placement for chest compression--a simpler technique.

BACKGROUND: Simplification of the techniques and teaching of resuscitation are advocated as ways of improving skill acquisition and retention. A simple method for teaching hand placement for chest compression has been described but not validated. OBJECTIVE: The objective of this study was to determine if instructing trainees simply to place their hands in the centre of the chest results in better initial and retained accuracy of hand placement than the usual method of first identifying anatomical landmarks. METHODS: Volunteers received instruction in basic CPR, being taught hand placement either by the standard method (33 subjects) or the simplified method (32 subjects). They were tested for accuracy of hand position before training, immediately afterwards and 6 weeks later. RESULTS: After training both groups showed an improvement in accuracy of hand placement but there was no significant difference in the degree of improvement between the groups (P=0.345), nor in the level of accuracy achieved (P=0.178). Six weeks after training, the Standard Group demonstrated a statistically significant deterioration in accuracy (P=0.001), whereas the Simple Group did not (P=0.561). By this time, however, there was no longer any difference in accuracy of hand placement for either group compared with before training (Standard Group P=0.912; Simple Group P=0.140). On the positive side, the Simple Group took significantly less time (2.90 s) than the Standard Group (4.43 s) to change from ventilation to chest compression (P=0.000003). CONCLUSIONS: Simplifying the teaching of correct hand placement for chest compression does not appear to lead to improvement in acquisition or retention of the skill. However, it does result in a significant reduction in the length of the pauses between ventilation and chest compression.

Performing chest compressions in a confined space.

Standard cardiopulmonary resuscitation (CPR) may be difficult to perform in a confined space. This study set out to evaluate alternative techniques of chest compression, which may be easier to perform in such situations. Nineteen airline employees, trained in basic life support (BLS), were recruited to take part in the study. Following refresher training in standard one- and two-person CPR, they were taught two alternative techniques of chest compression: one-person over-the-head (OTH) and two-person straddle (STR). Their performances of chest compression during one-person standard CPR (St-1) and two-person standard CPR (St-2) were then compared with their performances during OTH and STR using a recording manikin. There were no statistically significant differences between the two-person methods of compression (St-2 and STR) for any of the parameters measured. There were no statistically significant differences between the one-person methods of chest compression (St-1 and OTH) for the average compression rate, the number of chest compressions achieved in a minute, or the average hands-off time per cycle. For OTH the average compression depth was significantly less than for St-1 (P = 0.0149) and there were more compressions of incorrect depth (P = 0.0400). The average duty cycle was significantly higher for OTH (P = 0.0045). 30.4% of compressions were incorrectly placed for OTH compared with 7.7% for St-1 (P = 0.0025). It was concluded that the quality of chest compression during two-person straddle CPR compares favorably with chest compression during standard two-person CPR, and may be useful in situations where space is limited. If only one rescuer is available to perform CPR, and limited space makes it impossible to carry out standard CPR, over-the-head CPR is an alternative method. However, in this study, hand placement during chest compression was poor, and additional training may be necessary before it can be considered a safe technique.

Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator.

BACKGROUND: It has been shown that a computer-based audible feedback system can improve acquisition and retention of basic life support (BLS) skills. This system is being developed to work in association with an automated external defibrillator (AED). AIM: To determine if such a feedback system is likely to improve the quality of CPR performed by trained nurses whilst using an AED. METHOD: Thirty-six general nurses performed 3 min of BLS on a manikin connected to a laptop computer running an experimental software program. After initial testing they were randomly allocated to control or 'feedback' groups. Both groups then performed a further 3 min of BLS, but those in the feedback group received audible corrective instructions from the computer when errors of technique were detected. RESULTS: The group receiving feedback were significantly better than the control group at performing inflations (P=0.004) and achieving the correct depth of chest compression (P<0.0005). CONCLUSIONS: The results suggest that if the feedback system were to be incorporated into an AED, it could lead to better performance of CPR during a resuscitation attempt.

Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training.

A randomised controlled trial comparing staged teaching of cardiopulmonary resuscitation (CPR) with conventional training provided the additional opportunity to investigate skill acquisition and retention in those attending conventional CPR classes. All subjects were tested immediately after their first instruction period and again at 6-9 months at an unheralded home visit. We were able to assess how far performance was related to poor acquisition of skills and how far it was related to skill decay. Out of 262 subjects who were randomised to receive conventional CPR instruction, 166 were available for home testing at 6-9 months. An invitation to attend for re-training had been accepted by 39 of them. The remaining 127 who attended only a single class comprise the principal study group, with additional comparative observations on the smaller re-trained cohort. Important failings were observed in the acquisition of skills in all modalities tested after the initial instruction. These were particularly marked in skills related to ventilation. Immediately after a class, 68% of trainees performed an effective check of breathing, but only 33% opened the airway as taught and no more than 18% provided an ideal ventilation volume. The technique of chest compression was also less than ideal. Although 80% of subjects placed their hands in an acceptable position, compression to an adequate depth and an adequate rate of compression were achieved by 54 and 63%, respectively. Seventy-eight percent demonstrated a careful approach, and 46% remembered to call for help. A carotid pulse check was simulated by 61% of trainees. When tested 6-9 months later, skill deterioration from this baseline was observed in all modalities tested except for the ventilation volume. The skill decay was significant (P<0.05) for the careful approach, performing an effective breathing check, the carotid pulse check, placing the hands in an acceptable position for chest compression, and compressing at an optimal rate. The minority who attended for re-training showed a trend to protection against skill decay for seven of the ten variables, compared with those who had attended only one training session. This improvement was significant for only two of them, but all were relatively small with limited practical value. Many who attend conventional CPR classes fail to acquire the necessary skills, and the skills that are acquired decline appreciably over the subsequent 6-9 months. The value of conventional re-training was modest in this study of community volunteers.

Trials of teaching methods in basic life support (4): comparison of simulated CPR performance at unannounced home testing after conventional or staged training.

This study compares the retention of basic life support (BLS) skills after 6 and 12 months by lay persons trained either in a conventional manner, or using a staged approach. Three classes, each of 2h, were offered to volunteers over a period of 4 months. For the conventional group, the second and third classes consisted of review of skills. Those in the staged group were first taught chest compression alone; chest compression with ventilation in a ratio of 50:5 was introduced at the second class; full standard CPR was taught at the third class. A total of 495 volunteers entered the study, 262 being randomly allocated to conventional training, and 233 to staged training. More of those who received staged training attended a second (78 volunteers) and third class (41 volunteers), compared with those who received conventional training (36 and 17, respectively). The objective of this study, however, was to compare the strategies of the different training methods. A total of 291 volunteers (167 conventional and 124 staged training) were available for unannounced home testing of full conventional CPR 6 months after initial training, and 260 volunteers (135 conventional and 125 staged training) were tested at 12 months. At 6 months, those taught by the staged method were significantly better at time to first compression (P < 0.0001), compression rate (P = 0.024), and hand position (P = 0.0001). At 12 months, those taught by the staged method were significantly better at shouting for help (P = 0.005), time to first compression (P < 0.0001), and compression depth (P = 0.003). Those taught conventionally were significantly better at checking for a carotid pulse at both 6 and 12 months (P < 0.0001). These results suggest that training lay persons in basic life support skills using a staged approach leads to overall better skill retention at 6 and 12 months, and has other advantages including a greater willingness to re-attend follow-up classes.