Modified Two-Rescuer CPR With a Two-Handed Mask-Face Seal Technique Is Superior To Conventional Two-Rescuer CPR With a One-Handed Mask-Face Seal Technique.

BACKGROUND: Bag-valve-mask (BVM) ventilation using a two-handed mask-face seal has been shown to be superior to a one-handed mask-face seal during cardiopulmonary resuscitation (CPR). OBJECTIVE: We aimed to compare CPR quality metrics during simulation-based two-rescuer CPR with a modified two-handed mask-face seal technique and two-rescuer CPR with the conventional one-handed mask-face seal technique. METHODS: Participants performed two-rescuer CPR on a simulation manakin and alternated between the modified and conventional CPR methods. For the modified method, the first rescuer performed chest compressions and thereafter squeezed the BVM resuscitator bag during the ventilatory pause, while the second rescuer created a two-handed mask-face seal. For the conventional method, the first rescuer performed chest compressions and the second rescuer thereafter delivered rescue breaths by creating a mask-face seal with one hand and squeezing the BVM resuscitator bag with the other hand. RESULTS: Among the 40 participants that were enrolled, the mean ± standard deviation (SD) delivered respiratory volume was significantly higher for the modified two-rescuer method (319.4 ± 71.4 mL vs. 190.2 ± 50.5 mL; p < 0.0001). There were no statistically significant differences between the two methods with regard to mean ± SD compression rate (117.05 ± 9.67 compressions/min vs. 118.08 ± 10.99 compressions/min; p = 0.477), compression depth (52.80 ± 5.57 mm vs. 52.77 ± 6.77 mm; p = 0.980), chest compression fraction (75.92% ± 2.14% vs. 76.57% ± 2.57%; p = 0.186), and ventilatory pause time (4.62 ± 0.64 s vs. 4.56 ± 0.43 s; p = 0.288). CONCLUSIONS: With minor modifications to the conventional method of simulated two-rescuer CPR, rescuers can deliver significantly higher volumes of rescue breaths without compromising the quality of chest compressions.

Practical management of sudden cardiac arrest on the football field.

Sudden cardiac arrest (SCA) remains a tragic occurrence on the football field. The limits of preparticipation cardiovascular screening make it compulsory that prearranged emergency medical services be available at all football matches to immediately respond to any collapsed player. Management of SCA involves prompt recognition, immediate cardiopulmonary resuscitation (CPR) and early defibrillation. Any football player who collapses without contact with another player or obstacle should be regarded as being in SCA until proven otherwise. An automated external defibrillator (AED), or manual defibrillator if an AED is not available, should be immediately accessible on the field during competitions. This study presents guidelines for a practical and systematic approach to the management of SCA on the football field.

Competence in performing emergency skills: How good do doctors really think they are?

INTRODUCTION: Despite the differences in exposure and experience in dealing with medical emergencies, all doctors should nevertheless be competent to assist a patient in need of resuscitation. The objective of this study was to describe the level of self-assessed emergency skill competence that specialist trainees in various disciplines possessed as well as to identify factors that may have contributed to their level of self-perceived competence. METHODS: A prospective, cross-sectional, questionnaire study of various specialist trainees' self-perceived levels of competence in emergency skills was conducted across three academic hospitals in Johannesburg, South Africa. Trainees from General Surgery and Internal Medicine (Clinical) and Psychiatry and Radiology (Non-Clinical) rated their self-perceived level of competence in a list of basic, intermediate and advanced emergency skills according to a five-point Likert ranking scale. RESULTS: Ninety-four specialist trainees participated in the study - a response rate of 36%. The overall median competence rating for cardiac arrest resuscitation was 3.0 [IQR 3.0, 4.0] (i.e. intermediate). The median competence rating for cardiac arrest resuscitation in the clinical group (4.0) [IQR 3.0, 4.0] was higher than in the non-clinical group (3.0) [IQR 2.0, 3.0] (p < 0.001). Current or expired certification in Paediatric Advanced Life Support (PALS) or Advanced Paediatric Life Support (APLS) courses increased perceived competence and delays in starting specialisation resulted in a decrease in overall competence composite scores for each year of delay after internship. DISCUSSION: General Surgery and Internal Medicine trainees had a higher level of self-perceived competence in various emergency skills than their non- clinical counterparts. Current certification in advanced life support courses had a positive impact on trainees' self- perceived levels of competence in emergency skills. Specialist trainees who had less delay before starting their specialist training also demonstrated higher levels of perceived competence.

Adrenaline and amiodarone dosages in resuscitation: rectifying misinformation.

Despite the recognition of specialists in emergency medicine and the professionalisation of prehospital emergency care, international guidelines and consensus are often ignored, and the lag between guideline publication and translation into clinical practice is protracted. South African literature should reflect the latest evidence to guide resuscitation and safe patient care. This article addresses erroneous details regarding life-saving interventions in the South African Medicines Formulary, 10th edition. 

Resuscitation training in developing countries: a systematic review.

OBJECTIVE: To evaluate whether the inclusion of any specific resuscitation training educational strategy in developing countries improves outcomes. METHODS: As part of the International Liaison Committee on Resuscitation evidence evaluation process, a systematic review of the literature was conducted. The Cochrane database of systematic reviews; Medline; Google Scholar and EmBASE were searched using multiple search strategies. RESULTS: Forty-four papers were relevant to review, including 38 studies that provided support for the use of resuscitation training programs in developing countries. All studies that examined self-efficacy (15 studies) and student satisfaction (8 studies) reported improvement. There was no consistent testing method for educational outcomes across studies and few studies examined both educational outcomes and patient outcome (1 of 15 self-efficacy, 0 of 18 cognitive knowledge, 0 of 8 psychomotor skills, 0 of 5 simulated operational performance). Fourteen of 15 studies that examined patient survival were either newborn or trauma resuscitation, 1 adult resuscitation, and none were in pediatric resuscitation. Increased patient survival after resuscitation training was variable, with an absolute risk reduction that ranged from 0% to 34%. CONCLUSIONS: Resuscitation training in developing countries was well received and viewed as valuable training by the students and local counterparts. Important student, training environment characteristics, educational outcomes and patient outcomes were inconsistently defined and reported. Institution of training in trauma and newborn resuscitation in developing countries has significantly reduced mortality, but this has not been demonstrated with other training programs.