Subective versus objective assessment of chest compressions during CPR training in Europe
Survival from cardiac arrest is known to improve if patients receive good quality chest compressions as soon as possible. During cardiopulmonary resuscitation (CPR) training, subjective assessment of chest compression quality is still common despite the availability of more objective measurement through the manikin. This quantitative study compared peer-led subjective assessment of chest compressions of participants with objective data taken from a manikin.
Participants were recruited from three European countries and encompassed lay people, emergency medical services (EMS) personnel and hospital staff. Each group had 26 participants who were paired and asked to perform chest compressions for 2 minutes. During this time, both the manikin and the non-performing instructor were simultaneously recording the participants' performance. Both produced a score of each participant's compression rate, depth, hand position and complete release over the 2-minute period, and an overall score (pass mark). After a short break, the roles were reversed and the process repeated.
Observers from all backgrounds were consistently more generous in their assessment when compared with the manikin. The quality of chest compressions influences outcome following cardiac arrest; the findings of this study support increased use of objective assessment.
Impact of COVID-19 on out-of-hospital cardiac arrest
It seems inevitable that the COVID-19 pandemic will have impacted negatively upon the management of out-of-hospital cardiac arrest (OHCA). However, this study is one of the earliest to publish data around the impact of the COVID-19 pandemic on OHCA. The study took place in Victoria, Australia and compared 380 adult OHCA patients who received resuscitation between March and May 2020 with 1218 cases occurring during the same period in 2017−2019. No OHCA patients were COVID-19-positive. The researchers analysed the arrest incidence, characteristics, and survival from OHCA and performed regression analysis to understand the independent effect of the pandemic period on survival.
The incidence of OHCA did not differ during the pandemic period; however, initiation of resuscitation by EMS significantly decreased from 46.9% to 40.6% (p = 0.001). Arrests in public locations also decreased (20.8% versus 10.0% p < 0.001), as did initial shocks by public access defibrillation/first-responders (p = 0.037). Delays to key interventions such as time-to-first defibrillation significantly increased while survival-to-discharge decreased by 50% during the pandemic period (11.7% versus 6.1% p = 0.002). On adjusted analysis, the pandemic period was associated with a 50% reduction in survival-to-discharge. Part, but not all, of this survival decrease is attributed to disruption to the system-of-care during the pandemic.
UK paramedics' perceptions of pharmacology
This study sought to determine the perceived knowledge, attitudes and practices of UK paramedics regarding pharmacology and the legal, management and administration aspects of medicines. The researchers anonymously surveyed paramedics from a UK ambulance service using an online quantitative survey on the personal characteristics of the paramedic completing the survey; the paramedics' knowledge of pharmacology; the legal supply and administration of medicines; and the self-assessment of knowledge and confidence related to medicines management and administration. The primary outcome of this study was the percentage of correct answers.
In total, 251 of the approximately 1000 paramedics who were contacted responded to the survey. The number of correct answers per question ranged from 34.7 to 97.2%, while the mean percentage of correct answers was reported to be 79% (SD 10.0). The survey reports that higher correct knowledge scores were associated with paramedics who had: higher self-rated confidence; lower self-reported knowledge; and a higher-education route into paramedicine (particularly BSc).
The findings demonstrate considerable variation in the level of knowledge of medicines among paramedics within the ambulance service surveyed. The researchers suggest there is a need for additional education in this area, and for larger, multi-site research to evaluate any subsequent educational package.