Roberto Barcala-Furelos

Schoolchildren as life savers: At what age do they become strong enough?

OBJECTIVE It is not clear when schoolchildren become enough strong to perform good quality chest compressions (CC). Our purpose was to assess CC quality in schoolchildren. METHODS 721 children, 10-15 years old (YO) participated in 1 h hands-on training session. Subjects were tested during performing 2 min of continuous CC by means of Laerdal Resusci Anne(®) with Skillreporter(®), without feedback. RESULTS Mean compression depth (MCD) increased with age, from 30.7 mm in 10YO to 42.9 mm in 15YO (p<0.05) and was related to height, weight, and BMI. Boys delivered significantly deeper CC than girls in the 10, 13, 14 and 15YO groups (p<0.001). The percentage of children who achieved the MCD goal (50-60 mm), increased with age, from 0.0% at 10 years to 26.5% at 15 years (p<0.001). Mean compression rate (MCR) ranged from 121 min(-1) in 15YO to 134 min(-1) in 12YO. The percentage of children who achieved a CC rate inside the goal (100-120 min(-1)), ranged from 20.3% in 11YO to 31.0% in 15YO. Correct CC fraction was low and ranged from 2% in the 10YO to 22% in the 15YO (p<0.05). Children older than 13YO obtained better results than younger ones for all analyzed variables (p<0.001). Performance decreased with time: 12% of children achieved >50% of correct CC fraction in first minute, while only 5% did it in second minute (p<0.001). CONCLUSIONS In schoolchildren, age, sex and anthropometry are significant CPR quality factors. Although quality increases with age, their global performance is poor. Thirteen years is the minimum age to be able to achieve a minimum CPR quality similar to the one adult possess. CPR performance in schoolchildren significantly deteriorates within 60 s.

Effect of physical fatigue on the quality CPR: a water rescue study of lifeguards: Physical fatigue and quality CPR in a water rescue☆

PURPOSE The purpose of the study is to analyze the influence of the fatigue caused by a water rescue on the cardiopulmonary resuscitation (CPR) performance. METHODS The sample of our research is composed of a group of 60 lifeguards (30 men and 30 women) who have been trained at the Universities of A Coruña and Vigo. Two tests were conducted: the first test involved the execution of 5 min of CPR (rested), and the second one in performing water rescue and subsequent CPR (exhausted) for 5 minutes. The quality of the CPR at rest and at fatigue condition was compared. The recording instrument was the Laerdal Resusci Anne manikin. The time of the water rescue was also registered. RESULTS Gender does not significantly influence CPR, either at rest or at fatigue condition. However, the fatigue caused by rescue has a significant influence on the total quantity of chest compressions: rested (380 ± 38.64); exhausted (411 ± 56.09; P < .001) and ventilations: rested (24 ± 2.97); exhausted (26 ± 3.92; P < .001). Also in correct chest compressions: rested (285 ± 82.67); exhausted (246 ± 122.08; P = .02) and ventilations: rested (14 ± 7.09); exhausted (9 ± 6.67; P < .001). As far as the water rescue is concerned, men are faster (261 ± 34.58 s) when compared to women (326 ± 99.87 seconds; P = .001). CONCLUSION The accumulated fatigue during a water rescue performed by lifeguards reduces the quality of chest compressions and ventilations on the CPR.

Very brief training for laypeople in hands-only cardiopulmonary resuscitation. Effect of real-time feedback.

BACKGROUND Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest, but rates and performance quality remain low. Although training laypeople is a primary educational goal, the optimal strategy is not well defined. This study aimed to determine whether a short training with real-time feedback was able to improve hands-only CPR among untrained citizens. METHODS On the occasion of the 2015 World Heart Day and the European Restart a Heart Day, a pilot study involving 155 participants (81 laypeople, 74 health care professionals) was conducted. Participants were invited to briefly practice hands-only CPR on a manikin and were after evaluated during a 2-minute chest compression (CC) test. During training brief instructions regarding hand position, compression rate and depth according to the current guidelines were given and real-time feedback was provided by a Laerdal SkillReporting System. RESULTS Mean CC rate was significantly higher among health care professionals than among laypeople (119.07 ± 12.85 vs 113.02 ± 13.90 min(-1); P = .006), although both met the 100-120 CC min(-1) criterion. Laypeople achieved noninferior results regarding % of CC at adequate rate (51.46% ± 35.32% vs health care staff (55.97% ± 36.36%; P = .43) and depth (49.88% ± 38.58% vs 50.46% ± 37.17%; P = .92), % of CC with full-chest recoil (92.77% ± 17.17% vs 0.91% ± 18.84; P = .52), and adequate hand position (96.94% ± 14.78% vs 99.74 ± 1.98%; P = .11). The overall quality performance was greater than 70%, noninferior for citizens (81.23% ± 20.10%) vs health care staff (85.95% ± 14.78%; P = .10). CONCLUSION With a very brief training supported by hands-on instructor-led advice and visual feedback, naïve laypeople are able to perform good-quality CC-CPR. Simple instructions, feedback, and motivation were the key elements of this strategy, which could make feasible to train big numbers of citizens.

The effect of strength training on quality of prolonged basic cardiopulmonary resuscitation

BACKGROUND Providing high-quality chest compressions and rescue breaths are key elements in the effectiveness of cardio-pulmonary resuscitation. AIM To investigate the effects of a strength training programme on the quality of prolonged basic cardiopulmonary resuscitation on a manikin. METHODS This was a quasi-experimental trial. Thirty-nine participants with prior basic life support knowledge were randomised to an experimental or control group. They then performed a test of 10 min of chest compressions and mouth-to-mouth ventilation on manikins equipped with a skill reporter tool (baseline or test 1). The experimental group participated in a four-week strength training programme focused on the muscles involved in chest compressions. Both groups were subsequently tested again (test 2). RESULTS After training, the experimental group significantly increased the mean depth of compression (53.7 ± 2.3 mm vs. 49.9 ± 5.9 mm; p = 0.003) and the correct compression fraction (68.2 ± 21.0% vs. 46.4 ± 29.1%; p = 0.004). Trained subjects maintained chest compression quality over time better than the control group. The mean tidal volume delivered was higher in the experimental than in the control group (701.5 ± 187.0 mL vs. 584.8 ± 113.6 mL; p = 0.040) and above the current resuscitation guidelines. In test 2, the percentage of rescue breaths with excessive volume was higher in the experi-mental group than in the controls (31.5 ± 19.6% vs. 15.6 ± 13.0%; p = 0.007). CONCLUSIONS A simple strength training programme has a significant impact on the quality of chest compressions and its maintenance over time. Additional training is needed to avoid over-ventilation of potential patients.

Quality of chest compressions by Down syndrome people: A pilot trial

INTRODUCTION Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival after out-of-hospital cardiac arrest. Down syndrome (DS) citizens have improved their active engagement in society. The objective of this pilot trial was to investigate if they are able to perform quality chest compression-only CPR after a brief training. METHODS Nineteen DS young people (15-30 year old) and 20 University level subjects (18-29 year old) were trained by means of a short video and a brief hands-on session on manikins, to perform chest compression-only CPR. All participants were naïve in CPR. Chest compression (CC) quality (percentage of correct CC, CC rate and depth and chest complete release) was measured during a 2min test. CPR quality goal was according to 2010 European Resuscitation Council guidelines. RESULTS DS people had similar weight, lower height and a higher BMI than controls. They were able to deliver chest compression-only CPR but with higher mean CC rate (140±30 vs 123±12CC/min, p=0.03), less mean CC depth (35.4±10.3 vs 47.2±9.6mm, p=0.03) and lower % of full correct CC (13±18 vs 39±37, p=0.02) than controls. Differences were maintained when first and second minute of test were compared. CONCLUSIONS After a short instruction based on a brief video and hands-on session DS people were able to deliver CC but with poor quality.

Can surf-lifeguards perform a quality cardiopulmonary resuscitation sailing on a lifeboat? A quasi-experimental study

Purpose Drowning is a high-priority public health problem around the world. The European Resuscitation Council Guidelines for Resuscitation 2015 put special emphasis on special environments like open waters. Stopping the drowning process as soon as possible and starting an early cardiopulmonary resuscitation (CPR) improve survival. Inflatable rescue boats (IRBs) are used around the world in the water rescue of drowning victims. Our objective was to test the quality of CPR performed by surf-lifeguards while sailing on an IRB. Methods A quasi-experimental simulation trial was conducted in Tenerife (Canary Islands—Spain) on September 2015. Ten surf-lifeguards were asked to perform a 2 min CPR on manikins in four different scenarios: (1) onshore, (2) on adrift boat, (3) on a boat sailing at 5 knots and (4) on a boat sailing at 10 knots. CPR was performed individually and was measured by means of CPRmeter (Laerdal, Norway) located on the standard manikin. Repeated measures analysis of variance was used in order to analyse the differences between scenarios. Results The composite of all CPR variables was over 84% in all conditions, but it was lower when CPR was performed on board: onshore (96.49±3.58%) versus adrift (91.80±3.56, p=0.04), sailing at 5 knots (88.65±5.54, p=0.03) and sailing at 10 knots (84.74±5.56, p=0.001). Conclusion Surf-lifeguards are able to deliver good-quality CPR even on a moving IRB, but their performance is lower than onshore. This fact should be considered in real cases to balance the risk and benefits of CPR on board.

Automated external defibrillation skills by naive schoolchildren

AIM Early defibrillation should achieve the highest survival rates when applied within the first minutes after the collapse. Public access defibrillation programs have increased the population awareness of the importance of defibrillation. Schoolchildren should be trained in basic life support (BLS) skills and some countries have included BLS in their school syllabus. However, little is known of the current knowledge and ability of schoolchildren to use an automated external defibrillator (AED). METHODS A multicentric descriptive study, 1295 children from 6 to 16 years of age without previous BLS or AED training. Subjects performed a simulation with an AED and a manikin with no training or feedback and were evaluated by means of a checklist. RESULTS A total of 258 participants (19.9%) were able to simulate an effective and safe defibrillation in less than 3min and 52 (20.1% of this group) performed it successfully. A significant correlation between objective and age group was observed (G=0.172) (p<0.001). The average time to deliver a shock was 83.3±26.4s; that time decreased significantly with age [6 YO (108.3±40.4) vs. 16 YO (64.7±18.6)s] (p<0.001). CONCLUSIONS Around 20% of schoolchildren without prior training are able to use an AED correctly in less than 3min following the devices acoustic and visual instructions. However, only one-fifth of those who showed success managed to complete the procedure satisfactorily. These facts should be considered in order to provide a more accurate definition and effective implementation of BLS/AED teaching and training at schools.

Cardiac rehabilitation: The missing link to close the chain of survival?

Cardiovascular disease (CVD) is the most common condition underlying out-of-hospital cardiac arrest. Since the burden of CVD parallels that of cardiac arrest and both share risk factors, multidimensional approaches to tackle CVD are required. In this regard, cardiac rehabilitation could be an essential pillar of secondary prevention, perhaps the “missing link” to convert the linear chain of survival into a circular process, according to new research to appear in the journal Resuscitation. The study is available online as an accepted manuscript.

Comment on Cerland, L. et al. Incidence and Consequences of Near-Drowning-Related Pneumonia—A Descriptive Series from Martinique, French West Indies. Int. J. Environ. Res. Public Health 2017, 14, 1402

We read with great interest the recent paper by Cerland et al. on the frequency, nature, and consequences of post-drowning pneumonia[...].

Brief training in automated external defibrillation use for persons with down syndrome

Public access defibrillation programs aim to increase bystander esponse in case of cardiac arrest, including basic life support and arly defibrillation by means of available automated external defibillators (AED). All citizens should be able to use an AED after dequate but simple training.1 Most of young people with down yndrome (DS) experience moderate or important participation estrictions in daily activities and social roles.2 Offering them the ame learning opportunities as laypersons may be a good way to mprove their self-esteem and social role. Prior experiences have demonstrated that DS young people are apable to perform chest compressions (CC) only cardiopulmonary esuscitation (CPR).3 We invited members and staff of the Down Compostela oundation, Galicia, Spain, to participate in a brief training proram based on three simple steps: (1) short and easy lecture 5 min), (2) short funny video watching (https://www.youtube. om/watch?v=6W4zbqWWDs8) (7 min), (3) hands-on training ith AED-trainer (Laerdal) on manikin (Little Anne, Laerdal) 20 min). After the training, every participant was tested individually in simulated scenario. Performance was evaluated by means of a efibrillation procedure checklist that included three main issues: 1) time to defibrillation, (2) defibrillation objective, and (3) quality bjective. Thirty-nine participants were included, 27 DS and 12 occupaional therapist (OT) subjects. DS people were 52% male, and had mean age of 26,4 + 5,3 years. OT group were 92% male and had a ean age of 43,8 + 17,6 years. Groups were significantly different y age and sex (p < 0,001). All OT people and 17/22 (63%) DS participants accomplished the efibrillation objective (p = 0,014). Quality objective was obtained