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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Football referees as first responders in cardiac arrest. Assessment of a Basic Life Support training program.


Aim. To assess football referees´ cardiopulmonary resuscitation (CPR) skills and automated external defibrillator (AED) use in a simulated sport incident scenario, after a brief training program.

Material and Methods. Quasi-experimental study with 35 amateur league football referees. A test – retest of related samples was carried out after the training program. Theoretical and hands-on session lasted 30 minutes, with 1/10 instructor/participant ratio. CPR skills were measured using Wireless Skill Report software and AED use by means of a specific check list.

Results. A third of sample knew what an AED is but only 8% knew how to use it. After training, all participants achieved 70% or higher CPR quality scores and were able to use AED properly (54.2% without any incidence). Mean time to discharge was shorter for participants who accomplished the quality goal (p=0.022).

Conclusions. After a very brief and simple training program, football referees were able to perform a potentially effective CPR and use an AED correctly in a simulated scenario. Basic life support training should be implemented in football referees´ formative curriculum.

Key words: automated external defibrillator, referees, cardiac arrest, cardiopulmonary resuscitation, basic life support, training, sport, football

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Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?


Objective. We investigated whether data collected using the Resusci Anne SkillReporter were comparable with those collected using the CPRmeter (cardiopulmonary resuscitation meter -an accelerometer feedback device used to provide high-quality chest compressions).

Materials and Methods. Fifty continuous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Experiment 1: complete chest wall recoil; Experiment 2: incomplete chest wall recoil). The conditions were defined according to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each experimental condition alternately. Chest compression data were collected and analyzed using the Laerdal PC SkillReporting System and QCPR Review software.

Results. The mean difference in chest compression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001).

Conclusions. The chest compression depth measured by the Resusci Anne SkillReporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and researchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results.

Key words: cardiopulmonary resuscitation, manikins, feedback, education, training

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Does basic life support training simplification foster retention of life saving maneuvers?


Objectives. Simplification of Basic Life Support was proposed with the introduction of Chest-Compression only Cardio-Pulmonary Resuscitation (CC-CPR) as an alternative to Standard CPR (S-CPR). This study aimed to compare retention of knowledge, in the general public, of both CPR techniques (CC-CPR vs. S-CPR).

Design, setting and participants. Multicentric prospective comparative cohort study. A training program was conducted among 906 individuals who were assigned to CC-CPR or to S-CPR group. They were evaluated before training (T0), after training (T1) and six months later (T2) on 17 CPR assessment criteria, they were evaluated twice at each time period and one global CPR performance score.

Results. Initial knowledge was low. At T1, all CPR performance criteria improved significantly. Results were similar in both groups except for the rate of trainees calling for help and the time to turn on the automated external defibrillator and to deliver the first shock. At T2, the knowledge level was lower than at T1. Finally, CPR performance score was lower in both groups at T2 compared to T1 but statistically higher than at T0. CPR performance score was higher in the CC-CPR group than in the S-CPR group at T2 (p=0.041).

Conclusions. Performance score was significantly higher in the CC-CPR group. CC-CPR training seems to result in better retention and a faster reaction in the setting of an out of hospital cardiac arrest. Moreover, the retention of knowledge among a trained population fades partially with time. Regular CPR training should therefore be proposed to avoid the loss of benefit with time.

Key words: cardio-pulmonary resuscitation, basic life support, chest compression, mouth-to-mouth ventilation, training, retention

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Recognition of ventricular fibrillation concomitant with pacing artifacts


Introduction. In pre-hospital settings recognition of underlying rhythm in patients with ventricular stimulation can be difficult especially when a 3-lead electrocardiogram (ECG) is analyzed. This fact is particularly important in patients with life-threatening cardiac dysrhythmias. The pacing spikes in the ECG of a patient with cardiac arrest due to ventricular fibrillation may be misdiagnosed as QRS complexes.
Aim of the study. The aim of this study was to assess emergency medical care students’ accuracy in recognizing ventricular fibrillation when pacing spikes are present.
Material and methods. The study group consisted of 39 emergency medical care students, 16 males and 23 females, aged 21 – 23. Subjects were at the midpoint of their 3-year university healthcare professional education. Subjects were asked to interpret electrocardiograms presenting ventricular fibrillation with concomitant pacing artifacts, ventricular fibrillation and atrial fibrillation with ventricular pacing, respectively. Students were trained in recognition of ECG tracings presenting ventricular stimulation, atrial fibrillation and ventricular fibrillation. They were instructed that the duration of the QRS complex in adults is at least 0.06s and that pacemaker stimuli are shorter. Prior to the examination, an electrocardiogram similar to the abovementioned, with ventricular fibrillation and pacemaker stimuli, was not presented.
Results. Only one student (out of 39) recognized ventricular fibrillation with pacemaker stimuli present; the majority of students (92%) incorrectly interpreted the rhythm as atrial fibrillation or atrial flutter. The ECG with isolated ventricular fibrillation was correctly interpreted by all but two students who recognized polymorphic ventricular tachycardia and 62% of students correctly recognized ventricular pacing whereas none of them recognized atrial fibrillation.
Conclusions. 1. The skills of recognizing ventricular fibrillation in patients with concomitant ventricular pacing are poor among emergency medical care students.
2. The ECG tracing showing concomitant ventricular fibrillation and pacing stimuli should be included in teaching programs for emergency medical care students. An ongoing quality improvement program may reduce the rate of mistakes in ECG analysis in rare cases with life-threatening emergencies.

Key words: ventricular fibrillation, cardiopulmonary resuscitation, training, cardiac pacing

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