On behalf of the clinical support team I recently attended the Resuscitation Council (UK) Scientific Symposium. There were no major changes announced to the delivering of resuscitation training but you may find the following interesting.
Gasping Bodes Well for Survival After Cardiac Arrest
A study published in the September 19, 2017 issue of the Journal of the American College of Cardiology showed that gasping for air before or during CPR for out-of-hospital cardiac arrest (OHCA) is a strong predictor of survival with favourable brain function. Gasping (agonal breathing) is a natural reflex that enhances oxygenation and circulation during CPR and is a natural biomarker for the presence of brainstem activity. The authors note that gasping or agonal breathing can make it hard for bystanders to recognize cardiac arrest and so this finding should be emphasized during CPR training so that bystanders do not misinterpret gasping as normal breathing. (Source)
Bystander CPR in Children: Add Breaths to Compressions for Best Results
A study published in the February 2017 issue of JAMA Pediatrics showed that both conventional CPR (with rescue breaths) and compression-only CPR were associated with better outcomes than no CPR for children aged 1 to 18 years. However conventional CPR provides better outcomes than compression-only CPR and in infants bystander CPR was associated with improved outcomes than no CPR only when rescue breaths were also performed. (Source)
The stronger predictors of deterioration
Here is an interesting top 10 predictors of deterioration. Particularly for those who teach ILS and DILS, especially as respiratory rate is usually the observation least accurately recorded.
The top 10 predictors of deterioration are:
Respiratory rate 100%
Heart rate 77%
Systolic BP 63%
Diastolic BP 51%
Pulse pressure index* 48%
Blood urea 41%
Blood glucose 38%
Out of hospital cardiac arrests (OOHCA)
A number of factors impact of the survival rates for OOHCA.
- Norway now has 80% bystander CPR resulting in a survival rate of 25% for OOHCA. It has been taught in schools since the 1960s.
- Research has shown that the words the telephone dispatcher use can lead to a faster and shorter answer from the bystander. e.g. “tell me exactly what’s happened” – bystander answers in 9 seconds “tell me exactly what happened” – bystander answers in 18 seconds.
- Lifesaver interactive game. There is a new version of this game / app with teenagers as the rescuers to make it more relevant to that age group. It can be used with a desktop, laptop, tablet or smart phone. A smart phone can be attached to a virtual reality headset for a more immersive experience. The Resuscitation Council (UK) has carried out research in schools, where it has been used on desktops, and have found that on its own it was a good as face to face training (in terms of the children remembering what to do 6 months later) but it was most effective when used alongside face to face training.
Public Access Defibrillators (PADs)
- PADs are only used in 2.5% of OOHCA.
- Currently PADs are located by request so there may be 2 close together on one side of a town and none the other side. Some countries locate them by population density and morbidity rates amongst that population.
- Over 50% of the population don’t know where the nearest PAD is located.
- Bystander are afraid to use a PAD. They are concerned that they will use it incorrectly or that they will be more harm than good – this is the main reason why the signage on PADs has changed.
- Many countries are looking at the use of drones to deliver AEDs. Although in most cases the AED may arrive faster than an ambulance, there is concern that in an already stressful situation the bystander may be alarmed at the arrival of a drone.
- GoodSAM (Good Smartphone Activated Medics) is an emergency alerting and dispatching platform. The app allows bystanders to dial the emergency services, and at the same time notify nearby medically qualified responders of a medical emergency. By alerting responders of an emergency, GoodSAM connects those in need with those who have the skills to provide critical help before the emergency services arrive. The system has been developed so that dispatchers can activate the camera on the bystander’s mobile (with permission) to be able to assess the situation more accurately e.g. amount of blood loss, positioning of hands for chest compressions. (Source)
Written by Janet Brown 22nd November 2017