Andrew Lockey

Part 8: Education, implementation, and teams: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Current evidence demonstrates considerable variability in cardiac arrest survival in and out of hospital and, therefore, substantial opportunity to save many more lives.1–3 The Formula for Survival4 postulates that optimal survival from cardiac arrest requires high-quality science, education of lay providers and healthcare professionals, and a well-functioning Chain of Survival5 (implementation). The Education, Implementation, and Teams (EIT) Task Force of the International Liaison Committee on Resuscitation (ILCOR) set out to define the key PICO (population, intervention, comparator, outcome) questions related to resuscitation education (including teamwork skills) and systems-level implementation that would be reviewed by 2015. The selection of questions was supported through the use of an online anonymous task force member–only voting process where the results were considered in the ultimate consensus decisions of the task force. Topics from the 2010 evidence review process were scrutinized for relevance, the potential to improve outcomes, and the likelihood of new evidence being published since 2010. Finally, PICO questions for which the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was not as well developed at the time of PICO selection were deferred until at least after the 2015 cycle. We planned to reduce the total number of PICO questions reviewed to provide more in-depth and evidence-based reviews of the included questions. New topics were determined on the basis of the evolving literature and changes in resuscitation practice. Input on the selection of PICO questions was sought from the general public through the ILCOR website and from ILCOR member resuscitation councils through their council chairs and individual task force members. The EIT Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies6 and using the methodological approach proposed by the …

Kids Save Lives – ERC position statement on school children education in CPR.: “Hands that help – Training children is training for life”

Sudden out-of-hospital cardiac arrest (OHCA) with unsuccessful cardiopulmonary resuscitation (CPR) is the third leading cause of death in industrialised nations.1 After OHCA, the overall survival rates are 2–10%.2–4 In Europe and in the US together, 700,000 people die of OHCA every year. The same applies to other industrialised regions of the world. Many of these lives could be saved if more lay people provided immediate CPR.2 Emergency medical services (EMS) response times can be several (6–12) minutes or even longer.

European Resuscitation Council Guidelines for Resuscitation: 2017 update.

As a founding member of the International Liaison Committee n Resuscitation (ILCOR), the European Resuscitation Council (ERC) emains wholeheartedly committed to supporting ILCOR’s mission, ision and values [1]. One of the main functions of ILCOR over the ast 25 years has been to review published research evidence peridically to produce an international Consensus on Science with reatment Recommendations (CoSTR). Since 2000, ILCOR has proided an updated CoSTR every 5 years [2–5] which the ERC has ubsequently incorporated into its guidelines [6–8]. In recent years, he scale and pace of new clinical trials and observational studies n resuscitation science has grown exponentially. This prompted LCOR to review its approach to evidence synthesis and to transiion from a 5-yearly CoSTR to more regular updates, driven by the ublication of new science rather than arbitrary time point anchors.

Opportunities and barriers to cardiopulmonary resuscitation training in English secondary schools.

Objectives Cardiopulmonary resuscitation rates and survival from out-of-hospital cardiac arrest are poor in the UK compared with areas abroad that deliver mandatory training to all school children. We sought to identify barriers to training and develop a strategy to enable delivery of this training. Methods Qualitative analysis, comprising semistructured interviews and group discussions, covering 14 schools in the metropolitan borough of Calderdale in West Yorkshire. Results Only three schools out of 14 were delivering training to entire year groups. Barriers include lack of resources, lack of training for teachers and difficulty in initiating a programme. Strategies were developed to overcome these barriers with the result that four additional schools are now teaching a whole year group. There is no single solution and bespoke plans may be needed for each school. Conclusion The establishment of cardiopulmonary resuscitation training in secondary schools in the UK is achievable. The commonly perceived barriers to establishment of training are all surmountable, but solving them does not necessarily ensure universal coverage. Support from healthcare professionals, in particular public health, is essential to ensure that the training is as widespread as possible. Mandatory inclusion of this training on the school curriculum, as seen in other countries, would result in significantly improved survival rates from out-of-hospital cardiorespiratory arrest. Solutions to improve training have been proposed, which could be used in other parts of Europe where such training is not a mandatory requirement.

KIDS SAVE LIVES: School children education in resuscitation for Europe and the world

Sudden cardiac death is the third leading cause of death in industrialised nations. It is estimated that in Europe and in the United States, more than 700 000 patients die annually following sudden cardiac death, even when the emergency medical service has been activated and started cardiopulmonary

Equipping all citizens with the skills and equipment to be lifesavers

We agree with Malhotra and Rakhit that improved levels of bystander cardiopulmonary resuscitation (CPR) and reduced times to defibrillation for all victims of cardiac arrest are vital.1 The Resuscitation Council (UK) and British Heart Foundation (BHF) are jointly funding a research database to identify best practice and improve patient outcomes for those who experience pre-hospital cardiac arrest.2 …

Kids Save Lives – ERC‑Positionspapier zur Schülerausbildung in Wiederbelebung

Der plotzliche prahospitale Herzkreislaufstillstand mit erfolgloser kardiopulmonaler Reanimation (CPR) ist die dritthaufigste Todesursache in zivilisierten Landern. Die Uberlebensraten der Betroffenen liegen zwischen 2 % und 10 %. In Europa und in den USA sterben mehr als 700.000 Menschen pro Jahr an den Folgen des plotzlichen Herzkreislaufstillstands. Das Gleiche gilt auch fur andere Industrienationen weltweit. Viele dieser Leben konnten gerettet werden, wenn mehr Laien umgehend mit Wiederbelebungsmasnahmen beginnen wurden. Die Zeit bis zum Eintreffen des Rettungsdienstes kann einige (6–12) Minuten und auch langer dauern. Bedauerlicherweise beginnt das Gehirn nach einem Herzkreislaufstillstand bereits nach nur 3–5 min ohne Blutfluss unwiederbringlich zu sterben. Bis zu 70 % der plotzlichen Herzkreislaufstillstande sind von Familienmitgliedern, Freunden und umstehenden Laien bezeugt. So kann das potenziell todliche Intervall bis zum Eintreffen des...

Helfende Hände – Training von Kindern ist Training für’s Leben

Der plotzliche prahospitale Herzkreislaufstillstand mit erfolgloser kardiopulmonaler Reanimation (CPR) ist die dritthaufigste Todesursache in zivilisierten Landern. Die Uberlebensraten der Betroffenen liegen zwischen 2 % und 10 %. In Europa und in den USA sterben mehr als 700.000 Menschen pro Jahr an den Folgen des plotzlichen Herzkreislaufstillstands. Das Gleiche gilt auch fur andere Industrienationen weltweit. Viele dieser Leben konnten gerettet werden, wenn mehr Laien umgehend mit Wiederbelebungsmasnahmen beginnen wurden. Die Zeit bis zum Eintreffen des Rettungsdienstes kann einige (6–12) Minuten und auch langer dauern. Bedauerlicherweise beginnt das Gehirn nach einem Herzkreislaufstillstand bereits nach nur 3–5 min ohne Blutfluss unwiederbringlich zu sterben. Bis zu 70 % der plotzlichen Herzkreislaufstillstande sind von Familienmitgliedern, Freunden und umstehenden Laien bezeugt. So kann das potenziell todliche Intervall bis zum Eintreffen des...

Education for cardiac arrest – Prevention AND treatment

We read with interest the paper by Smith et al.1 in which they ecommend reducing training in advanced life support (ALS) and ubstituting training in Immediate Life Support and in the recogniion and response to clinical deterioration. We agree that the latter s very important and for this reason the ALS course includes teachng on recognition and management of the deteriorating patient, revention of cardiac arrest and the fundamental importance of on-technical skills in delivering resuscitation effectively. It also aises awareness of the importance of good post-resuscitation care n achieving optimal outcomes. The original concept of using cardiopulmonary resuscitation CPR) to rescue ‘hearts too GOOD to die’2 referred to the treatment f ventricular fibrillation occurring in the acute phase of myocardial nfarction. Prompt delivery of CPR by trained staff in coronary care nits was shown to achieve better outcomes than occurred when imilar patients received attempted CPR on general wards.3 Absence of evidence of benefit of ALS training on outcome from ardiac arrest is not evidence of absence. Indeed, when an event is nfrequent and its causes are multifactorial, obtaining statistically ignificant evidence of benefit from an intervention may be very ifficult. We believe that it is wrong to presume that if an event is nfrequent, it is acceptable not to be fully trained and prepared for t. Airline pilots train rigorously to deal with very infrequent emerency events: how many of us would willingly board an aircraft if e thought that they did not? Junior doctors find cardiac arrest and delivery of CPR stressful.4 n feedback following ALS training they report improved confience, and that is more likely to be sustained if they receive ebriefing after cardiac arrests and regular training updates.4 The roposed alternative, having ‘permanent’ cardiac arrest teams on onstant standby in every hospital, would have huge staffing and ost implications and is probably unachievable in the UK. Delivery of CPR is all the more stressful for staff when inapproriate resuscitation attempts result from failure of others to make nticipatory decisions about CPR.4 Smith and colleagues make cant reference to the importance of a DNACPR policy and trainng in decisions about CPR as a means of preventing inappropriate PR attempts.5

Cardiac arrest: the science and practice of resuscitation medicine

Edited by N Paradis, H Halperin, K Kern, V Wenzel, D Chamberlain. . Cambridge University Press, Cambridge, 2007, pp 1338, hardback, £110. ISBN 9780521847001. This 1338 page textbook, coming 10 years since the first edition, presents a contemporary evidence base for virtually every intervention and aspect of resuscitation medicine. It is aimed at “clinicians who wish to practise both the science and the art of resuscitation medicine”. International recommendations for resuscitation are now updated every 5 years. The last update to the guidelines was in 2005 and this book delivers an extremely comprehensive and thorough rationale behind this guidance. The editors and chapter authors are established and …