No abstract available.
Advanced Cardiac Life Support*

No abstract available.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation*

Background. Despite the recent advances in advanced cardiac life support (ACLS), there has been no significant improvement in survival among patients who undergo cardiac arrest. To date, there are no local guidelines on the requirements or standards of in-hospital cardiac arrest teams in the Philippines. In addition, there are still no studies on the outcomes of cardiac arrests among adult patients in a tertiary hospital in the Philippines. Objectives. The objective of this study is to investigate patient-, event-, and hospital-related factors associated with survival among adult patients who underwent in-hospital cardiac arrest in the service wards and intensive care units of a tertiary hospital. Methods. This is a prospective cross-sectional study conducted over three months in 2018. Patient-, event- and hospital-related data were collected from each patient with a cardiac arrest event who was referred to the cardiac arrest teams based on the modified Utstein form of reporting cardiac arrests. Survival to discharge from cardiac arrest was the main outcome. Results. The study included 119 patients, 47.9% male, with a mean age of 50.1 years (SD 16.7). Survival rate was 6.7%. The mean response time did not differ between survival group (1.46 minutes) and mortality group (1.82 minutes) (p value = 0.26). The presence of a shockable initial rhythm (3.6% vs 3/8; p value = 0.01), shorter lag time to initiation of electrical therapy (6.0 vs 9.3 ± 5.6 min; p value = 0.02), shorter time to establishment of an airway (2.75 ± 1.6 vs. 6.98 ± 5.2 min; p value = 0.01), and shorter duration of resuscitation (7 ± 4.6 vs. 13.0 ± 7.9 min; p value = 0.01) were significantly associated with survival. The presence of underlying illnesses is associated with higher mortality. The most common hospital-related problems identified were the need to cover long distances, delay in the call, and the lack of elevators. Conclusion. The survival rate of patients who underwent cardiac arrest and resuscitation by a cardiac arrest team is low. The initial presenting rhythm, lag time to initiation of electrical therapy, time to establishment of airway, duration of resuscitation, as well as the underlying disease can significantly affect survival. Streamlining the resources of the hospital to address these matters can have an impact on survival.
Advanced Cardiac Life Support ; Heart Arrest

PURPOSE: In this study, we compared the effects of constructivist and traditional teaching strategies in teaching advanced cardiac life support (ACLS) skills during simulation-based training (SBT). METHODS: A randomized, pre- and post-test control group study was designed to examine this issue in 29 third-year emergency medical technician (EMT) students. Participants received SBT through constructivist SBT (CSBT) or traditional lecture-based SBT (TSBT) teaching strategies. We evaluated the effects of the simulation training on ACLS knowledge, and performance immediately after practice and at retention. RESULTS: The knowledge and performance of the CSBT group were higher than compared with the TSBT group (mean knowledge 33.3+/-5.03 vs. 29.5+/-5.33, p=0.36; and mean performance 12.20+/-1.85 vs. 8.85+/-3.54, p=0.010). However, there was no difference between two groups in retention between groups 1 month later (mean knowledge 31.86+/-4.45 vs. 31.50+/-4.65, p=0.825; and mean performance 12.13+/-0.99 vs. 12.57+/-1.78, p=0.283). CONCLUSION: CSBT is more effective with regard to knowledge acquisition and performance than TSBT. Further studies are needed to explore ways of improving retention and transfer of knowledge from simulated to real situations with SBT.
Advanced Cardiac Life Support ; Emergency Medical Technicians ; Humans ; Retention (Psychology)

A primary cardiac arrest is rare in children. The usual course begins with respiratory arrest and culminates in profound bradycardia or asystole and cardiovascular collapse, so it is vitally important to quickly restore ventilation in pediatric patients(phone-fast). Children over 8 years of age follow the same sequence as adults; that is calling emergency medical services before providing rescue breathing(phone-first).
Adult ; Advanced Cardiac Life Support ; Bradycardia ; Cardiopulmonary Resuscitation* ; Child ; Emergency Medical Services ; Heart Arrest ; Humans ; Ventilation

PURPOSE: The purpose of this study was to provide direction to improvement of advanced cardiovascular life support (ACLS) training in Korea. METHODS: We conducted a retrospective analysis of the questionnaire written by 55 instructors of the 31 institutions registered in the Korean Association of Cardiopulmonary Resuscitation (KACPR) from 2009 and 2010. The contents of the questionnaire consisted of an evaluation of the ACLS curriculum, modification of the ACLS curriculum, problems of ACLS training, and other open-ended answers. RESULTS: In this questionnaire, the result for assessment of the lecture on acute coronary syndrome was intermediate, that answer was given by the majority, 40.0%. The result for assessment of the lecture on stroke was intermediate, that answer was given by the majority, 40.0%. In addition, the result for the necessity of the lecture on acute coronary syndrome was intermediate, 25.5%, which was the most common response. The result for the necessity of the lecture on stroke was intermediate, 27.3%, which was the most common response. In the ACLS curriculum, 14.5% of respondents responded that simulation curriculum should be strengthened; 20.0% of participants responded that training on equipment and medical technique should be enhanced. CONCLUSION: Lecture without practice should be avoided and simulation-oriented education should be strengthened in the ACLS course.
Acute Coronary Syndrome ; Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Curriculum ; Surveys and Questionnaires ; Korea ; Retrospective Studies ; Stroke

PURPOSE: It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA. METHODS: Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases. RESULTS: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%). CONCLUSION: A FC/TBL format for ACLS marginally improved written test results.
Advanced Cardiac Life Support* ; California* ; Choice Behavior ; Humans ; Learning* ; Students, Medical* ; United States

PURPOSE: Shorter response time is very important for critically-ill patients. The study utilized a linear planning and simulation technique to design a two-tiered system with advanced life support (ALS) ambulances. METHODS: We collected the ambulance run-sheet data from a fire department from January, 2006 to December, 2007 to determine emergency medical service (EMS) demands. The location of patient ambulance stations were mapped by geocoding and the most appropriate number and location of ambulances was calculated with the linear planning method. The planning result was validated with a discrete simulation. RESULTS: The initial enrollment was 227,377 cases of 119 calls. After geocoding, 170,472 (74.9%) cases were directly matched, 56,899 (25.0%) were indirectly matched, and (0.1%) were not matched. The latter were excluded. Using the linear planning method, the number of additional ambulances was calculated for a new two-tiered ambulance system that could achieve a 90% service level. From the current single-tiered system with 112 ambulances to a two-tiered system of 211 basic life support (BLS) units and 40 ALS units, the BLS service level for minor patients could be raised to 90%. For severely-ill patients , a BLS and ALS service level of up to 82% and 89%, respectively, service level could be achieved. The new two-tiered system was validated with the discrete simulation. After the simulation, the BLS and ALS service level for severely-ill patients reached 85% and 93%, respectively. As well, a 100% BLS service level for minor patients was achieved. CONCLUSION: Linear planning and discrete simulation with GIS data enabled the simulation of a two-tiered ambulance system that can shorten the response time of the current single-tiered system.
Advanced Cardiac Life Support ; Ambulances ; Emergencies ; Emergency Medical Services ; Fires ; Geographic Mapping ; Humans ; Reaction Time

PURPOSE: Hyperventilation during cardiopulmonary resuscitation (CPR) is common and can be detrimental to survival. We designed a method for delivery of an appropriate rate of ventilation during CPR by setting a compression numbers to ventilation ratio. METHODS: We conducted a virtual simulation trial using 12 randomly sorted actual CPR video files. Participants provided ventilation using a self-inflating bag while watching one minute of CPR video clips utilizing pre-set compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively. Ventilation rates per minute were manually calculated and analyzed. RESULTS: Eight medical doctors and eight emergency medical technician students were included. Among the three groups, significant different mean (S.D) ventilation rate per min (compression to ventilation ratio were 10:1, 12:1, and 15:1) was (9.9 (1.3) vs. 8.8 (1.0) vs. 7.2 (0.8), respectively; p<0.0001). Proportion of the number of appropriately delivered ventilations was 62.5%, 89.6%, and 38.0% for compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively (p<0.0001). CONCLUSION: Compression to ventilation ratio of 12:1 resulted in a significantly appropriate ventilation rate, compared with the ratio of 10:1 or 15:1. Pre-set compression to ventilation ratio of 12:1 seems to be a novel method for delivery of an appropriate number of ventilations during CPR after establishment of an advanced airway.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Ventilation

BACKGROUND: Provision of early adequate chest compression remains a standard of care for optimal outcome in cardiopulmonary arrest. Inadequate chest compression during CPR may result in the insufficient blood flow to preserve critical organ function. Therefore, authors performed this study to characterize fatigue-induced deterioration in the adequacy of closed-chest compression performed over period 5 minutes and to determine whether CPR providers recognize the effects of fatigue on compression adequacy. METHOD: Prospectively we carried out the study with an electronic CPR teaching mannequin(ResusciAnnie with Skillmeter; Laerdal) placed on a patient stretcher. The mannequin was equipped with a real-time remote display that records the numbers of total and correct compressions. Compression are judged as correct by the mannequin if both depth and placement are appropriate in keeping with standard advanced cardiac life support guidelines. Our study subjects were 27 nurses and doctors, each with certification of BLS and experience of CPR in ED. Each subject performed a 5 minute session of chest compressions. Also subjects were asked to verbally indicate the point during their 5 minute compression period at which they felt too fatigued to provide effective compressions. For statistical analysis, one-way repeated-measures ANOVA and regression test was used. RESULT: The number of total compressions attempted per minute did not decrease significantly(P=.565). But we found 81.0% of compressions performed during the first 1 minute to be correct. The percentages for minutes 2 through 5 were decreased significantly as follows: 73.0%, 68.0%, 65.0%, 57.0%(P=.0003). Regression analysis revealed a decrement in compression adequacy of 13.0% per minutes after the first 1 minute of compression. The time of indicated fatigue was 220+/-29 seconds(mean+/-SD) CONCLUSION: Although compression rate was maintained over time, chest compression quality declined significantly over the study period. Because CPR providers could not recognize their ability to provide proper compression, cardiac arrest team leaders should carefully monitor compression adequacy and change the CPR providers each 3 minutes during CPR to assure maximally effective care for patients receiving CPR.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Certification ; Fatigue ; Heart Arrest ; Humans ; Manikins ; Prospective Studies ; Standard of Care ; Thorax