Checking for Breathing: Evaluation of the Diagnostic Capability of Emergency Medical Services Personnel, Physicians, Medical Students, and Medical Laypersons

Ruppert, M.; Reith, M. W.; Widmann, Jörg H; Lackner, Christian; Kerkmann, R.; Schweiberer, L.; Peter, K.

doi:10.1016/s0196-0644(99)70097-1

Cited by 89 publications

(50 citation statements)

References 10 publications

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“…Therefore, it is likely that educated bystanders who have strong will to save the victims but insufficient skill in checking the pulse [25] perform ventilation-only BCPR. It has been shown that healthcare providers also have difficulty in pulse detection [26,27]. Once bystanders judge the presence of respiratory arrest and initiate ventilation-only BCPR, transition to cardiac arrest may be more difficult to detect [9], and ventilation-only BCPR may be continued until EMT arrival.…”

Section: Discussionmentioning

confidence: 99%

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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Aim: To determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR.Methods: From out-of-hospital cardiac arrest (OHCA) data prospectively collected from 2005 to 2011 in Japan, we extracted data for 210,134 bystander-witnessed OHCAs with complete datasets but no prehospital involvement of physician [no BCPR, 115,733;2,093; 61,075; and conventional (compressions + ventilations) BCPR, 31,233] and determined the factors associated with 1-month neurologically favourable survival using simple and multivariable logistic regression analyses. In 91,885 patients with known BCPR durations, we determined the factors associated with ventilation-only BCPR.Results: The rate of survival in the no BCPR, ventilation-only, compression-only and conventional group was 2.8%, 3.9%, 4.5% and 5.0%, respectively. After adjustment for other factors associated with outcomes, the survival rate in the ventilation-only group was higher than that in the no BCPR group (adjusted OR; 95% CI, 1.29; 1.01-1.63), but lower than that in the compression-only (0.76; 0.59-0.96) or conventional groups (0.70; 0.55-0.89). Conventional CPR had the highest OR for survival in almost all OHCA subgroups. The adjusted OR (95% CI) for survival after dividing BCPR into ventilation and compression components were 1.19 (1.11-1.27) and 1.60 (1.51-1.69), respectively. Older guidelines, female sex, younger patient age, bystander-initiated CPR without instruction, early BCPR and short BCPR duration were associated with ventilation-only BCPR.Conclusions: Ventilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs.Word count: 247

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Section: Discussionmentioning

confidence: 99%

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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“…114 But even health care professionals cannot rapidly and accurately determine if a victim is breathing or if a pulse is present. [115][116][117][118] Laymen have even more difficulty in verifying whether there is a pulse. 119 Laymen should not check for the absence of a pulse before initiating CPR.…”

Section: Ii-3 Inform Trainees About What To Expect During Resuscitatimentioning

confidence: 99%

Understanding and improving low bystander CPR rates: a systematic review of the literature

Vaillancourt

Stiell

Wells

2008

CJEM

142

110

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Objectives: Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training. Methods: For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence. Results: We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatchassisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's selftraining video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone. Conclusion:We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates. RÉSUMÉ Objectifs : La réanimation cardio-respiratoire (RCR) est un maillon essentiel, quoique faible, de la chaîne de survie lors de la survenue d'un arrêt cardiaque hors de l'hôpital. Nous avons cherché à comprendre les déterminants du taux de passants pouvant administrer la RCR et les facteurs liés à une formation efficace. Méthodes : Dans le cadre de cette revue systématique, nous avons analysé 11 bases de données électroniques, un registre d'essais cliniques et neuf sites Web scientifiques. Nous avons réalisé des recherches manuelles et communiqué avec six experts du contenu. Nous avons examiné sans restriction toutes les communications portant sur les questions suivantes : qui devrait apprendre la RCR, ce qu'on devrait enseigner, QUAND la formation devrait être renouvelée, où les cours de

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“…Occasional or agonal gasping can occur in the first minutes after SCA and is often misinterpreted as normal breathing, especially by lay responders. 76 Occasional gasping does not represent adequate breathing and, if present, should not prevent rescuers from initiating CPR. Assessment of signs of circulation and the presence of a pulse by lay rescuers and health care professionals can also be inaccurate.…”

Section: Recognition Of Sudden Cardiac Arrestmentioning

confidence: 99%

Inter Association Task Force Recommendations on Emergency Preparedness andManagement of Sudden Cardiac Arrest in High School andCollege Athletic Programs: A Consensus Statement

Drezner

Courson

Roberts

et al. 2007

Prehospital Emergency Care

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Objective: To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA.Background: Sudden cardiac arrest is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes.Recommendations: Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishment of an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of on-site responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.Key Words: sudden cardiac death, athletes, emergency action plan, automated external defibrillators S udden cardiac arrest (SCA) is the leading cause of death in young athletes. 1,2 Athletes are considered the healthiest members of our society, and their unexpected death during training or competition is a catastrophic event that stimulates debate regarding both preparticipation screening evaluations and appropriate emergency planning for athletic events. Despite preparticipation screening, healthy-appearing competitive athletes may harbor unsuspected cardiovascular diseases with the potential to cause sudden death. 3 With the increasing availability of automated external defibrillators (AEDs) at athletic events, there is potential for effective secondary prevention of sudden cardiac death (SCD). The presence and timely access of AEDs at sporting venues provide a means of early defibrillation not only for athletes but also for spectators, coaches, officials, event staff, and other attendees on campus in the case of an unexpected SCA.Many health-related organizations have guidelines for managing SCA during athletic practices and competitions. However, these guidelines have not directly linked emergency planning and...

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Checking for Breathing: Evaluation of the Diagnostic Capability of Emergency Medical Services Personnel, Physicians, Medical Students, and Medical Laypersons

Cited by 89 publications

References 10 publications

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

Understanding and improving low bystander CPR rates: a systematic review of the literature

Inter Association Task Force Recommendations on Emergency Preparedness andManagement of Sudden Cardiac Arrest in High School andCollege Athletic Programs: A Consensus Statement

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