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Introduction: Chest compression fraction (CCF) is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation. Targeting a CCF of at least 60% is intended to limit interruptions in compressions and maximize coronary perfusion during resuscitation. We aimed to identify the mean CCF and its relationship with various factors affecting it. Methods: Patients presenting to the emergency department in cardiac arrest at a single center were prospectively included in this study. Resuscitation was provided by trained health-care providers. The feedback device Cprmeter2™ was placed on the patient's sternum at the beginning of resuscitation. The total time taken for the entire resuscitation was noted by the device and CCF calculated. Results: The mean CCF was analyzed using descriptive statistics and was found to be 71.60% ± 7.52%. The total duration of resuscitation (R = -0.55, P = < 0.001, min-max, 2.02-34.31, mean 12.25 ± 6.54), number of people giving chest compressions (R = -0.48, P = < 0.001, min-max, 1-6, mean 4.04 ± 1.12), and total number of team members in resuscitation (R = -0.50, P = < 0.001, min-max, 4-10, mean 6.65 ± 1.32) had negative correlation with CCF. Diurnal variation (day, n = 35; mean 69.20% ± 7% and night, n = 20; mean 75.80% ± 5.6%, P = 0.001) and patients receiving defibrillation (receiving n = 10 mean 67.00% ± 4.11% and not receiving n = 45 mean 72.62 ± 7.42%, P = 0.005) were found to significantly affect CCF. Conclusion: The mean CCF for cardiac arrest patients was well within the targets of guideline recommendation. CCF decreased when resuscitation lasted longer, during daytime when the defibrillator was used, the total team members increased, and also when the number of people giving chest compressions increased. CCF during resuscitation may improve if there is a focus on improving these factors and requires validation in multicentric settings.
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Road traffic injuries (RTIs) stands as one of the leading causes of mortality and morbidity across the globe. Effective injury surveillance systems and pre-hospital and in-hospital interventions set up in developing countries have shown promising results in controlling the problem. This study aimed to standardise and evaluate an evidence-based intervention for safety, efficacy and quality of post-crash pre-hospital and in-hospital trauma care services to improve the outcome in RTI victims. In addition, it establishes the android-based trauma registry for effective RTI surveillance. This multi-centric, prospective, observational study is commissioned by the Indian Council of Medical Research (ICMR) as a National Task Force Project. This study is being conducted in five sites, viz., Anand, Bengaluru, Delhi, Lucknow and Thrissur located across India. Each centre will have a level I, two level II and three level III trauma hospitals. The study will be carried out in four phases namely: i) preparatory phase, ii) trauma registry establishment and pre-intervention data collection, iii) intervention and iv) impact evaluation. The preparatory phase, which lasts for four months includes the situational analysis pertaining to managing RTIs. Trauma registry will be initiated from the fifth month. Pre-intervention data will be collected for six months. The intervention will be conducted for six months in the form of prehospital notification, training for trauma care providers and trauma care quality improvement. Post-intervention data collection will continue for 12 months and the impact of the intervention will be assessed. The primary outcome measure will be early preventable mortality, defined as death at 24 hours after admission for patients with a calculated probability of survival >50% based on their injury severity score.
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INTRODUCTION: Our current medical curriculum devotes a large percentage of time to knowledge acquisition by means of didactic lectures. Psychomotor skill acquisition takes a back seat. Certain lifesaving skills like basic life support skill training have not even made an appearance in the current curriculum. Equal time distribution to cognitive and psychomotor skills should be allotted for MBBS trainees, which is a very practical subject. Simulation can prove to be a valuable tool in imparting skill training. The present study aims to evaluate the efficacy of different teaching modalities in imparting lifesaving skills among first-year MBBS students. MATERIALS AND METHODS: This cross-sectional study was conducted among 33 first-year students who consented to participate. Approval was obtained from the institutional ethics committee. The students were divided into three groups, each undergoing either didactic lecture or animation-based videos or simulation studies. Pretest, posttest, and skills tests were administered to them. One-way analysis of variance (ANOVA) and paired t test were the statistical tests employed using SPSS version 21. RESULTS: The pretest and posttest scores were comparable in the three groups while the improvement in the posttest scores in all the three groups was significant. The skills test was significantly better in the group undergoing simulation training compared to the other groups. CONCLUSION: Didactic, animation, and simulation are all good methods in imparting cognitive knowledge, but simulation is the method of choice in imparting psychomotor skills. CLINICAL SIGNIFICANCE: An overhauling of the medical curriculum to include more skills training to the budding doctors using simulation-based techniques is recommended. HOW TO CITE THIS ARTICLE: Suseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study. IJCCM 2019;23(11): 509-512.
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INTRODUCTION: In Russell's viper bites, due to the lack of a better alternative, whole blood clotting test (WBCT) remains the standard test even though its reliability and sensitivity has been shown to be low. Activated partial thromboplastin time (aPTT)-based clot waveform analysis (CWA) is an optic absorbance assay that can be used as a global clotting test. In this study, the objective was to assess the changes in CWA and to compare CWA to WBCT and aPTT in patients with Russell's viper envenomation. METHODS: The datum was collected prospectively over 2 months as a pilot observational study in a tertiary care center. All proven cases of Russell's viper-envenomated individuals with preliminary CWA data and WBCT were included in the study. The clot wave (CW) of the five individuals, which met all the stringent inclusion criteria, was analyzed and interpreted. RESULTS: CW absorbance sigmoid waveform was deranged in all 5 cases, of which 4 showed a change in CWA even before an abnormal aPTT. Three of the 5 had a normal WBCT but showed early changes in CWA. Atypical biphasic waveform reported in disseminated intravascular coagulation in other prior studies is seen in venom-induced consumptive coagulopathy also. In all patients where a second derivative was plotted, the second (lower) phase of the second derivative showed a slow rise to baseline. CONCLUSION: CWA showed changes which provided information earlier than the conventional coagulation studies in the snakebite victims studied. While aPTT or WBCT reflects clotting time, CWA conveys the dynamic process of clot formation and stabilization. CWA may reveal disorders of clotting in snakebite victims before the conventional tests become abnormal. Future research should assess the speed and accuracy of the test in diagnosing hemotoxic envenomation and its potential role in guiding antivenom therapy.