Jerry P. Nolan

A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency

This study sought to determine whether using the Resuscitation Council UK’s iResus© application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty‐one doctors (advanced life support‐trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group (median (IQR [range]) 84.5 (75.5–92.5 [64–96])) compared with the control group (72 (62–87 [52–95]); p = 0.02). Use of the iResus application significantly improves the performance of an advanced life support‐certified doctor during a simulated medical emergency. Further studies are needed to determine if iResus can improve care in the clinical setting.

Epidemiology and outcomes from out-of-hospital cardiac arrests in England

INTRODUCTION This study reports the epidemiology and outcomes from out-of-hospital cardiac arrest (OHCA) in England during 2014. METHODS Prospective observational study from the national OHCA registry. The incidence, demographic and outcomes of patients who were treated for an OHCA between 1st January 2014 and 31st December 2014 in 10 English ambulance service (EMS) regions, serving a population of almost 54 million, are reported in accordance with Utstein recommendations. RESULTS 28,729 OHCA cases of EMS treated cardiac arrests were reported (53 per 100,000 of resident population). The mean age was 68.6 (SD=19.6) years and 41.3% were female. Most (83%) occurred in a place of residence, 52.7% were witnessed by either the EMS or a bystander. In non-EMS witnessed cases, 55.2% received bystander CPR whilst public access defibrillation was used rarely (2.3%). Cardiac aetiology was the leading cause of cardiac arrest (60.9%). The initial rhythm was asystole in 42.4% of all cases and was shockable (VF or pVT) in 20.6%. Return of spontaneous circulation at hospital transfer was evident in 25.8% (n=6302) and survival to hospital discharge was 7.9%. CONCLUSION Cardiac arrest is an important cause of death in England. With less than one in ten patients surviving, there is scope to improve outcomes. Survival rates were highest amongst those who received bystander CPR and public access defibrillation.

Ethik der Reanimation und Entscheidungen am Lebensende. Kapitel 11 der Leitlinien zur Reanimation 2015 des European Resuscitation Council

Der traditionelle medizinorientierte Ansatz mit seiner Betonung auf „Tue Gutes“ („beneficence“) hat sich verschoben in Richtung eines ausgewogenen patientenzentrierten Ansatzes mit größerem Gewicht auf der Autonomie des Patienten. Dies hat zu vermehrter Verständnisbereitschaft und Interaktion zwischen Patient und professionellem Helfer geführt. Zukünftige Leitlinien können aus der Beteiligung aller Interessengruppen Nutzen ziehen: Vertreter der Öffentlichkeit, Patienten, Überlebende und die Gesellschaft als aktive Partner beim Verständnis und der Umsetzung der ethischen Prinzipien. Inhalt und Umsetzung der traditionellen ethischen Prinzipien stehen im Kontext eines patientenbezogenen Ansatzes hinsichtlich der Reanimation: 5 Autonomie, einschließlich der Respektierung persönlicher Präferenzen, die in Patientenverfügungen ausgedrückt werden; dies impliziert eine korrekte Information und Kommunikation. 5 Fürsorge (Gutes tun – „beneficence“), einschließlich Prognosestellung, wann begonnen werden soll, Aussichtslosigkeit, Fortführung der CPR („cardiopulmonary resuscitation“ – kardiopulmonale Reanimation) während des Transports, besondere Situationen – mit klarer Unterscheidung zwischen plötzlichem Kreislaufstillstand und zu erwartendem Stillstand von kardialer Funktion und Atmung in terminalen Situationen. 5 Schadensvermeidung („non-maleficence“), einschließlich DNAR/ DNACPR-Anweisungen, wann beendet oder nicht begonnen werden soll, sowie Beteiligung des Patienten oder seines Vertreters. 5 Gerechtigkeit und gleicher Zugang, einschließlich der Vermeidung von Ungleichheiten.

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.

The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future.

2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCORs efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Resuscitation Guidelines 2015.

Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Cochin University Hospital (APHP) and Paris Descartes University, Paris, France Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, slo, Norway Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy

Ethik der Reanimation und Entscheidungen am Lebensende@@@Ethics of resuscitation and end-of-life decisions

Der traditionelle medizinorientierte Ansatz mit seiner Betonung auf „Tue Gutes“ („beneficence“) hat sich verschoben in Richtung eines ausgewogenen patientenzentrierten Ansatzes mit größerem Gewicht auf der Autonomie des Patienten. Dies hat zu vermehrter Verständnisbereitschaft und Interaktion zwischen Patient und professionellem Helfer geführt. Zukünftige Leitlinien können aus der Beteiligung aller Interessengruppen Nutzen ziehen: Vertreter der Öffentlichkeit, Patienten, Überlebende und die Gesellschaft als aktive Partner beim Verständnis und der Umsetzung der ethischen Prinzipien. Inhalt und Umsetzung der traditionellen ethischen Prinzipien stehen im Kontext eines patientenbezogenen Ansatzes hinsichtlich der Reanimation: 5 Autonomie, einschließlich der Respektierung persönlicher Präferenzen, die in Patientenverfügungen ausgedrückt werden; dies impliziert eine korrekte Information und Kommunikation. 5 Fürsorge (Gutes tun – „beneficence“), einschließlich Prognosestellung, wann begonnen werden soll, Aussichtslosigkeit, Fortführung der CPR („cardiopulmonary resuscitation“ – kardiopulmonale Reanimation) während des Transports, besondere Situationen – mit klarer Unterscheidung zwischen plötzlichem Kreislaufstillstand und zu erwartendem Stillstand von kardialer Funktion und Atmung in terminalen Situationen. 5 Schadensvermeidung („non-maleficence“), einschließlich DNAR/ DNACPR-Anweisungen, wann beendet oder nicht begonnen werden soll, sowie Beteiligung des Patienten oder seines Vertreters. 5 Gerechtigkeit und gleicher Zugang, einschließlich der Vermeidung von Ungleichheiten.

Section 3. Adult advanced life support: European Resuscitation Council Guidelines for Resuscitation 2015.

Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany Warwick Medical School, University of Warwick, Coventry, UK Heart of England NHS Foundation Trust, Birmingham, UK Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, elsinki, Finland Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway edical Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biom outhampton, UK

Ethik der Reanimation und Entscheidungen am Lebensende@@@Ethics of resuscitation and end-of-life decisions: Kapitel 11 der Leitlinien zur Reanimation 2015 des European Resuscitation Council

Notfall Rettungsmed2017 ·20 (Suppl 1):S119–S132 DOI 10.1007/s10049-017-0329-z Online publiziert: 6. Juli 2017

Erratum zu: Kurzdarstellung. Kapitel 1 der Leitlinien zur Reanimation 2015 des European Resuscitation Council@@@Erratum to: Executive Summary. Section 1 of the European Resuscitation Council Guidelines for Resuscitation 2015

Notfall Rettungsmed 2017 · 20:538–539 DOI 10.1007/s10049-017-0338-y Online publiziert: 11. Juli 2017