Using an Immersive Virtual Reality System to Assess Lay Provider Response to an Unannounced Simulated Sudden Cardiac Arrest in the Out-of-Hospital Setting.

BACKGROUND: A sudden cardiac arrest (SCA) occurs when the heart abruptly stops beating; because of the nature of SCA, capturing data in the out-of-hospital setting from actual bystander response is difficult. Current technologies such as virtual reality (VR) allow the creation of scenarios programmed for heightened realism. No studies have used an immersive VR system to observe lay bystander response. OBJECTIVE: We sought to characterize lay bystander response to an unannounced simulated VR SCA event during a multisensory scenario. METHODS: Using a VR wearable device combined with a cardiopulmonary resuscitation (CPR) recording manikin, we created a 3-minute multisensory SCA scenario that allowed for the observation of lay bystander response. Subjects were unaware of the nature of the emergency event but were told to respond how they would to an emergency situation. Subject's ability to proceed through the American Heart Association's Chain of Survival and their CPR quality were recorded. Frequencies and percentages were calculated using descriptive statistics. RESULTS: Between June 2016 and June 2017, 119 lay subjects were enrolled. Of those, 92% asked for 911 to be called, 81% attempted CPR, 13% requested an automated external defibrillator (AED), and 6% used the AED; 82% stated that they felt as if they were at a real SCA event. Cardiopulmonary resuscitation data were collected (n = 81), the mean CC rate was 93.5 ± 22.4 cpm, and the mean CC depth was 38.4 ± 13.8 mm. CONCLUSIONS: In our unannounced, immersive VR SCA observational study of lay bystanders, most subjects attempted CPR, although the majority did not use an AED.

Examining the Use of a Social Media Campaign to Increase Engagement for the American Heart Association 2017 Resuscitation Science Symposium.

BACKGROUND: The Resuscitation Science Symposium (ReSS) is the dedicated international forum for resuscitation science at the American Heart Association's Scientific Sessions. In an attempt to increase curated content and social media presence during ReSS 2017, the Journal of the American Heart Association (JAHA) coordinated an inaugural social media campaign. METHODS AND RESULTS: Before ReSS, 8 resuscitation science professionals were recruited from a convenience sample of attendees at ReSS 2017. Each blogger was assigned to either a morning or an afternoon session, responsible for "live tweeting" with the associated hashtags #ReSS17 and #AHA17. Twitter analytics from the 8 bloggers were collected from November 10 to 13, 2017. The primary outcome was Twitter impressions. Secondary outcomes included Twitter engagement and Twitter engagement rate. In total, 8 bloggers (63% male) generated 591 tweets that garnered 261 050 impressions, 8013 engagements, 928 retweets, 1653 likes, 292 hashtag clicks, and a median engagement rate of 2.4%. Total engagement, likes, and hashtag clicks were highest on day 2; total impressions were highest on day 3, and retweets were highest on day 4. Total impressions were highly correlated with the total number of tweets (r=0.87; P=0.005) and baseline number of Twitter followers for each blogger (r=0.78; P=0.02). CONCLUSION: In this inaugural social media campaign for the 2017 American Heart Association ReSS, the degree of online engagement with this content by end users was quite good when evaluated by social media standards. Benchmarks for end-user interactions in the scientific community are undefined and will require further study.

Cardiopulmonary Resuscitation Training Disparities in the United States.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is associated with increased survival from cardiac arrest, yet bystander CPR rates are low in many communities. The overall prevalence of CPR training in the United States and associated individual-level disparities are unknown. We sought to measure the national prevalence of CPR training and hypothesized that older age and lower socioeconomic status would be independently associated with a lower likelihood of CPR training. METHODS AND RESULTS: We administered a cross-sectional telephone survey to a nationally representative adult sample. We assessed the demographics of individuals trained in CPR within 2 years (currently trained) and those who had been trained in CPR at some point in time (ever trained). The association of CPR training and demographic variables were tested using survey weighted logistic regression. Between September 2015 and November 2015, 9022 individuals completed the survey; 18% reported being currently trained in CPR, and 65% reported training at some point previously. For each year of increased age, the likelihood of being currently CPR trained or ever trained decreased (currently trained: odds ratio, 0.98; 95% CI, 0.97-0.99; P<0.01; ever trained: OR, 0.99; 95% CI, 0.98-0.99; P=0.04). Furthermore, there was a greater then 4-fold difference in odds of being currently CPR trained from the 30-39 to 70-79 year old age groups (95% CI, 0.10-0.23). Factors associated with a lower likelihood of CPR training were lesser educational attainment and lower household income (P<0.01 for each of these variables). CONCLUSIONS: A minority of respondents reported current training in CPR. Older age, lesser education, and lower income were associated with reduced likelihood of CPR training. These findings illustrate important gaps in US CPR education and suggest the need to develop tailored CPR training efforts to address this variability.

Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management*.

OBJECTIVE: Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. DESIGN: Retrospective chart review. SETTING: Two academic medical centers from May 2005 to December 2012. PATIENTS: The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management initiation, total duration of resuscitation, withdrawal of care, and location of arrest. CONCLUSION: Patients with different Cerebral Performance Category scores at discharge have significantly different survival trajectories. Favorable Cerebral Performance Category at hospital discharge predicts better long-term outcomes of survivors of cardiac arrest who received targeted temperature management than those with less favorable Cerebral Performance Category scores.