Diss. Univ. Zürich, 2009. / Sonderdruck aus: Schweizer Monatsschrift für Zahnmedizin. Bd. 117, Nr. 8, 2007.

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Background: During the last 20 years there have been different approaches to teaching nurse students cardiopulmonary resuscitation (CPR). Receiving CPR with compressions of adequate depth and frequency, and ventilations of adequate volume improves the chance of survival. The aim of this study was to evaluate effects of different types of feedback on CPR skills among nursing students. Methods: A pilot study with an explorative approach including 30 nurse students. Students was randomized in three groups; 1) instructor-led training followed by self-training without feedback, 2) self-training with visual graphic feedback, and 3) self-training with voice advisory manikin (VAM). Outcomes were correct compression deep, frequency, hand position and release, and correct ventilation volume and flow. If performance was correct to 70%, students were considered to have reached approved level. The students also answered questions about theoretical knowledge about CPR. Results: In technical skills, group 2 had significant higher level of correct ventilation volume compared with the other group. Both group 1 and 3 did not reach the level of 70% correct performance. Group 1 and 2 had significant higher level of correct deep of compressions compared with group 3 which did not reach the 70% level. There was no difference in performance between groups in other parameters. Conclusion: This pilot study suggests that visual graphic feedback is promising and seemed to be more effective than self-training with voice advisory manikin and instructor-led training with followed self-training without feedback.

Background-Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. Methods and Results-We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein-style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P<0.0001), with an odds ratio of 1.63 (95% confidence interval, 1.17-2.25). After exclusions, 379 of 459 cases were eligible for process analysis. When callers described abnormal breathing, the rates of telecommunicator OHCA recognition, CPR instruction, and telephone CPR were lower than when callers did not use a breathing descriptor (79.7% versus 93.0%, P<0.0001; 65.4% versus 72.5%, P=0.0078; and 60.2% versus 66.9%, P=0.0123, respectively). The time interval between call receipt and OHCA recognition was longer when the caller used a breathing descriptor (118.5 versus 73.5 seconds, P<0.0001). Conclusions-Descriptors of abnormal breathing are associated with improved outcomes but also with delays in the identification of OHCA. Familiarizing telecommunicators with these descriptors may improve the telephone CPR process including OHCA recognition for patients with increased probability of survival.

Cancer was the most common cause of the death in Taiwan in the past two decades. The recent advanced improvements of cancer treatment took endless encouragements and hopes to patients and their families, so they intended aggressively while dealing with the issue of death because of the decline of mortality rate and prolonged mean lifespan. It was difficult for families and doctors to decide whether to prolong life by life sustaing treatments (including cardiopulmonary resuscitation) or to sign Do-Not-Resuscitate (DNR) consent for terminal cancer patients .We want to analyze the related factors toward terminal cancer patients DNR and point out some ones correlated closely with the time of signing consent in this restrospective research. We corrected 80 DNR consents signed by terminal cancer patients or their families from one general teaching hospital in south Taiwan and analyzed factors toward the time of signing consents. Results of this study showed that the time of signing consents was very close with that of their death . Only 12.5% of the patients with survival more than 2 weeks after signing DNR consents, 55% of the patients or their families did not sign the consents until five days before their death, 30% of the patients died in 6-14 days after signing DNR consents, and there were even more twenty percent (21.25%) of the patients died in the day of which the consents were just signed by their families. The patients¡¦age, gender, kinds of their primary cancer, whether the pulmonary or pleural metastasis were present or not, and the treatments of these patients had no significant correlations with the time of signing DNR consents. Only three factors including of education level of patients, whether the patients¡¦illness was critical while signing consents and kinds of patients¡¦painkiller use contributed to the time of DNR signing significantly in this research. 72.5% of these patients had the degree for the primary school, and 80% of the patients or their families signed the consents just when the patients¡¦illness was critical. There were 32 patients with degree of the primary school and only 4 with degree of the junior high school within the patients wih survival more than 6 days after signing DNR consents (p value =0.003); There were 53.75% of the patients had ever used opioid painkillers while siging DNR consents, 25% of them had even received morphine for pain control. For the patients with survival more than 6 days after signing DNR consents, there were 18 patients prescribed opioid painkillers, and 26 patients without taking painkillers that meaned significant difference (p value =0.011); For the patients with critical illness while signing DNR consents, it meaned statistic difference for that 42 patients got survival more than 6 days and 23 patients with survival less than 6 days. (p value =0.000). We highly suggest to inforce the knowledge of hospice care to people in community and the colleagues of doctors and nurses by any kinds of education and introduction. We all need to pay more attentions to psychiatric status of terminal cancer patients and supply adequate help and care for them, so we could all get more close to meanings of human life.

Objectives: To describe learning outcomes of undergraduate nursing students following an online basic life support course (BLS). Methods: An online BLS course was developed and administered to 94 nursing students. Pre- and post-tests were used to assess theoretical learning. Checklist simulations and feedback devices were used to assess the cardiopulmonary resuscitation (CPR) skills of the 62 students who completed the course. Results: A paired t-test revealed a significant increase in learning [pre-test (6.4 +/- 1.61), post-test (9.3 +/- 0.82), p < 0.001]. The increase in the average grade after taking the online course was significant (p < 0.001). No learning differences (p = 0.475) had been observed between 1st and 2nd year (9.20 +/- 1.60), and between 3rd and 4th year (9.67 +/- 0.61) students. A CPR simulation was performed after completing the course: students checked for a response (90%), exposed the chest (98%), checked for breathing (97%), called emergency services (76%), requested for a defibrillator (92%), checked for a pulse (77%), positioned their hands properly (87%), performed 30 compressions/cycle (95%), performed compressions of at least 5 cm depth (89%), released the chest (90%), applied two breaths (97%), used the automated external defibrillator (97%), and positioned the pads (100%). Conclusions: The online course was an effective method for teaching and learning key BLS skills wherein students were able to accurately apply BLS procedures during the CPR simulation. This short-term online training, which likely improves learning and self-efficacy in BLS providers, can be used for the continuing education of health professionals.

Magister Curationis - MCur / Cardiopulmonary resuscitation (CPR) is a core emergency skill in which all nurses need to be proficient to save the lives of patients. It is important for nurses working in psychiatric hospitals to administer CPR correctly should the need arise. However, they rarely perform CPR as the patients they care for are generally not physical ill, unlike patients admitted in general hospitals. Given the paucity of literature on CPR in psychiatric hospitals, this study aimed at investigating the attitudes towards CPR and the CPR competency of nurses working at a hospital for intellectually disabled people in the Western Cape, South Africa

Certified Athletic Trainers (ATCs) are expected to perform cardiopulmonary resuscitation (CPR) on athletes experiencing cardiac arrest, regardless of whether the athlete is wearing protective athletic equipment. The goal of this research was to determine if ATCs were able to deliver high-quality CPR over and under football shoulder pads. Forty-one ATCs completed CPR according to 2015 AHA guidelines over and under shoulder pads fitted on a manikin. CPR quality was measured with the Resusci Anne Wireless SkillReporter. Data were analyzed to compare CPR performed over and under the shoulder pads. Overall CPR score, chest compression depth, and ventilation volume were statistically significant when CPR was performed over the equipment. Equipment removal revealed to cause a delay in compression initiation. Although the data from CPR measures suggest the removal of equipment is indicated, the prolonged delay of compressions due to equipment removal should be taken into consideration before establishing best-practice recommendations.

Background-High catecholamine concentrations are cytotoxic to cardiac myocytes. We hypothesized that myocardial interstitial catecholamine levels are greatly elevated immediately after long-duration ventricular fibrillation (VF), defibrillation, and reperfusion and that the short-acting β-antagonist esmolol administered at reperfusion would protect against this catecholamine surge and improve survival. Methods and Results-In part 1 of this study, catecholamines from myocardial interstitial fluid (ISF) and aortic and coronary sinus plasma were quantified by use of 3H-labeled radioenzymatic assay in 8 open-chest, anesthetized pigs. Eight minutes of electrically induced VF was followed by internal defibrillation and reperfusion. By 4 minutes of VF, ISF norepinephrine increased significantly, from 1.3±0.3 to 7.4±2.4 ng/mL. Epinephrine increased significantly, from 0.4±0.2 to 1.5±0.7 ng/mL. ISF norepinephrine and epinephrine peaked at 219.2±92.1 and 63.7±25.1 ng/mL after defibrillation and reperfusion and decreased significantly to 12.2±3.5 and 6.7±3.1 ng/mL 23 minutes after defibrillation. Transcardiac catecholamine changes were similar. In part 2, 8 minutes of VF was followed by external defibrillation in anesthetized, closed-chest pigs. Animals received 1.0 mg/kg esmolol (n=8) or saline (n=8) intravenously at the start of cardiopulmonary resuscitation (CPR). Advanced cardiac life support, including CPR and epinephrine, was delivered to both groups. Esmolol before reperfusion improved return of spontaneous circulation and 4-hour survival (7/8 versus 3/8 survivors, χ2 P<0.05). Conclusions-Transcardiac and ISF norepinephrine and epinephrine levels are briefly massively elevated after 8 minutes of VF, defibrillation, and reperfusion. A short-acting β-antagonist administered immediately after defibrillation improves return of spontaneous circulation and 4-hour survival after this prolonged VF.

O ensino de enfermagem em ressuscitação cardiopulmonar (RCP) deve refletir a prática baseada em evidências, as diretrizes da American Heart Assossiation (AHA) e basear-se nos cenários de prática clínica incluindo o reconhecimento da parada cardiorrespiratória, em qualquer ambiente de atenção à saúde. Este estudo trata-se de uma revisão integrativa da literatura e tem como referencial teórico a prática baseada em evidência. Buscou-se identificar e analisar na literatura as evidências oriundas dos estudos primários que abordassem as estratégias de ensino e aprendizagem da RCP em adultos, para os estudantes de graduação em enfermagem. A busca foi realizada nas bases de dados PUBMED, EMBASE, CINAHL e LILACS, no período de 2000 a 2011. Das 591 referências encontradas, 18 estudos primários fizeram parte desta amostra. Foi realizada a extração e análise dos dados, por dois revisores. Foram encontradas as seguintes evidências nos estudos primários: sete de nível II, dois de nível III, dois nível IV e sete estudos de nível VI. Instrução por pares, aprendizagem assistida por computador, aprendizagem baseada em problemas, simulações de alta e baixa finalidade, autoinstrução por leitura de manuais do BLS, autoinstrução por vídeo e a estratégia tradicional têm sido explorados pelos pesquisadores para ensinar e avaliar o nível de aquisição e da retenção dos conhecimentos e das habilidades dos estudantes de enfermagem em RCP. Os estudos de evidência II apresentam comparações entre a estratégia de simulação com o padrão da AHA, com os menequins de média e alta fidelidade, com os estudantes de diferentes níveis de formação; dois estudos comparam estratégias Instrução por pares com a estratégia de ensino tradicional e outro estudo comparando a autoinstrução com a tradicional e com a web-based. O uso da estratégia de simulação com cenários estruturados e com manequins de alta fidelidade mostrou-se, em relação as demais estratégias, a que melhor apresentou subsído para a retenção do conhecimento e aquisição de habilidades na realização da RCP, de acordo com as recomendações das diretrizes da AHA. Os estudos primários mostraram que a retenção do conhecimento e das habilidades apresenta declínio com o passar do tempo, independente da estratégia utilizada pelo professor, sendo necessárias sessões de repetição para que as habilidades não se deteriorem. / Nursing teaching of cardiopulmonary resuscitation (CPR) should reflect the evidence-based practice, the guidelines of the American Heart Association (AHA), and be based on clinical practice scenarios, including the recognition of cardiopulmonary arrest in any environment of health care. This study is an integrative literature review and has the evidence-based practice as the theoretical referential. It aimed to identify and analyze in the literature the evidences from the primary studies that addressed teaching and learning strategies of CPR in adults for undergraduate nursing students. The search was conducted in the PUBMED, EMBASE, CINAHL and LILACS databases in the period from 2000 to 2011. Of the 591 found references, 18 primary studies were part of this sample. Data extraction and analysis were performed by two reviewers. The following evidence in the primary studies were found: seven of level II, three of level III, two of level IV, and six studies of level VI. Peer instruction, computer-assisted learning, problem based learning, high and low-fidelity simulations, self education by reading BLS manual, self education by video and traditional strategy have been explored by researchers to teach and evaluate the level of acquisition and retention of knowledge and skills of nursing students in CPR. Studies of evidence II show comparisons among the simulation strategy with the AHA standard, with the medium and high-fidelity mannequins, and with students of different levels of training; two studies comparing peer instruction strategy with traditional teaching strategy, and another study comparing self education with traditional and web-based strategies. The use of simulation strategy with structured scenarios and high-fidelity mannequins was that showed, in relation to other strategies, better subsidy for the retention of knowledge and skill acquisition in CPR, according to the recommendations and guidelines of the AHA. The primary studies showed that the retention of knowledge and skills declined over time, regardless of the strategy used by the professor, requiring repeated sessions so that skills do not deteriorate.