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How do nurses interpret low voltage ventricular fibrillation during simulated cardiopulmonary resuscitation? Are they as good as we think?
Abstracts / Resuscitation 118S (2017) e43–e90
Conclusions: -
There is a higher use of fibrinolytics in OHCA in 2016. Higher use does not reflect in survival rate. Most of fibrinolytics were used in non suspected APE OHCA. Recommended CPR time after administration of fibrinolytics is not accomplished. - There seems to be a contagion effect on treatment in OHCA due to suspected APE and OHCA of cardiac etiology, which according to literature is contraindicated. http://dx.doi.org/10.1016/j.resuscitation.2017.08.149 AP049 How do nurses interpret low voltage ventricular fibrillation during simulated cardiopulmonary resuscitation? Are they as good as we think? Lukasz Czyzewski 1,∗ , Lukasz Szarpak 1 , Jerzy Ladny 2 , Jacek Smereka 3 1
Medical University of Warsaw, Warsaw, Poland Medical University Bialystok, Bialystok, Poland 3 Wroclaw Medical University, Wroclaw, Poland 2
Purpose of the study: The ability to interpret electrocardiographic (ECG) rhythms associated with cardiac arrest in a necessary skill, having a direct impact on the quality of advanced life support (ALS) and the patient survival. The aim of the study was to evaluate the ability to recognize low voltage ventricular fibrillation (LvVF) during simulated cardiopulmonary resuscitation (CPR) performed by nurses. Materials and methods: The study, conducted during ALS workshops, involved 42 nurses working in emergency units or anesthesiology and intensive care units. The nurses performed CPR according to the European Resuscitation Council (ERC) guidelines. During the exercise resuscitation, the team consisted of 2 independent instructors and a nurse acting as team leader. The resuscitation team leader was required to interpret the ECG rhythm and administer the appropriate treatment, including drugs and defibrillation. CPR was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). During the 10-min scenario, the ECG rhythms were randomly altered, always including the occurrence of LvVF. Results: The median age of participants was 31 (interquartile range, IQR, 26–44) years, and work experience – 6.5 (IQR; 3–8) years. LvVF was recognized only by 17 nurses (40.5%) In the case of LvVF occurrence, only 33.3% participants increased the ECG amplitude and changed the ECG lead. Among the 16 nurses who recognized LvVF, 15 performed defibrillation, and 2 followed the guidelines for non-shockable rhythms. Conclusions: There is a need to introduce compulsory periodic training for the nursing staff to focus on recognizing rhythms associated with cardiac arrest and implementing procedures based on the 2015 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2017.08.150
e61
AP050 A statistics based teaching intervention to aid foundation doctors when discussing cardiopulmonary resuscitation (CPR) Mayurun Ramadas ∗ , Lubna Ghani, Ben Clark Imperial College School of Medicine, London, UK Purpose: The United Kingdom Foundation Programme (UKFPO) syllabus states a foundation doctor should be able to discuss why CPR is not appropriate [1]). Discussions and questions pertaining to CPR success rate and complications are an often challenging yet a vital part of medical practice [2]. We implemented a teaching intervention that aimed to equip Foundation doctors’ with key National Cardiac Arrest Audit (NCAA) statistical data [3] to help them field such questions. Materials and method: Prior to the teaching a survey was given to foundation doctors (n = 36). Subsequently, a mandatory teaching session was delivered for them. The session identified key cardiac arrest demographics, success rate and complications based on the latest resus council NCAA data and how to express this appropriately. This was followed up by an immediate evaluation survey. A three month follow up survey evaluated whether the workshop resulted in self-rated behaviour change and long term impact. It was emphasised in the session that a statistics approach to CPR discussions was optional and one out of a variety of approaches that could be used if doctors felt confident discussing the statistics involved. Results: Qualitative pre-session data clearly highlighted that foundation doctors face challenging questions and statements from patients and family about ‘CPR prognosis/statistics’. Immediate post-session evaluation revealed foundation doctors found the teaching to be relevant, interactive and helpful to their training using a 5-point Likert scale (mean = 4.6). The three month postsession questionnaire showed that 69% of foundation doctors used the NCAA statistics provided in the workshop in their clinical practice when discussing why CPR was not appropriate. The same proportion felt the workshop had increased their confidence when discussing why CPR is not appropriate. Conclusion: Our results show many foundation doctors are fielding challenging questions and statements from patients and relatives about CPR. A useful approach to answering such questions is by using evidence based statistical data based on national cardiac arrest data (NCAA). The teaching session equipped them with statistical data and communication strategies which they found relevant and helpful to their training. Moreover, long term impact and behavioural change was noted as the majority of foundation doctors were using the statistics provided to them in their clinical practice three months post session to help them explain with confidence why CPR was not appropriate. References [1].UKFPO. Foundation Programme Syllabus; 2017. Available at: http://www. foundationprogramme.nhs.uk/curriculum/Syllabus; Clinical care; End of Life. [2].Etheridge Z, Gatland E. When and how to discuss “do not resuscitate” decisions with patients. BMJ (Clin Res ed) 2015;350:h2640. [3].National Cardiac Arrest Audit (NCAA) 2015/2016, Resuscitation council UK.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.151
Conclusions: -
There is a higher use of fibrinolytics in OHCA in 2016. Higher use does not reflect in survival rate. Most of fibrinolytics were used in non suspected APE OHCA. Recommended CPR time after administration of fibrinolytics is not accomplished. - There seems to be a contagion effect on treatment in OHCA due to suspected APE and OHCA of cardiac etiology, which according to literature is contraindicated. http://dx.doi.org/10.1016/j.resuscitation.2017.08.149 AP049 How do nurses interpret low voltage ventricular fibrillation during simulated cardiopulmonary resuscitation? Are they as good as we think? Lukasz Czyzewski 1,∗ , Lukasz Szarpak 1 , Jerzy Ladny 2 , Jacek Smereka 3 1
Medical University of Warsaw, Warsaw, Poland Medical University Bialystok, Bialystok, Poland 3 Wroclaw Medical University, Wroclaw, Poland 2
Purpose of the study: The ability to interpret electrocardiographic (ECG) rhythms associated with cardiac arrest in a necessary skill, having a direct impact on the quality of advanced life support (ALS) and the patient survival. The aim of the study was to evaluate the ability to recognize low voltage ventricular fibrillation (LvVF) during simulated cardiopulmonary resuscitation (CPR) performed by nurses. Materials and methods: The study, conducted during ALS workshops, involved 42 nurses working in emergency units or anesthesiology and intensive care units. The nurses performed CPR according to the European Resuscitation Council (ERC) guidelines. During the exercise resuscitation, the team consisted of 2 independent instructors and a nurse acting as team leader. The resuscitation team leader was required to interpret the ECG rhythm and administer the appropriate treatment, including drugs and defibrillation. CPR was applied in a MegaCode Kelly manikin (Laerdal, Stavanger, Norway) with the use of a LIFEPACK 15 manual defibrillator (Physio-Control, the Netherlands). During the 10-min scenario, the ECG rhythms were randomly altered, always including the occurrence of LvVF. Results: The median age of participants was 31 (interquartile range, IQR, 26–44) years, and work experience – 6.5 (IQR; 3–8) years. LvVF was recognized only by 17 nurses (40.5%) In the case of LvVF occurrence, only 33.3% participants increased the ECG amplitude and changed the ECG lead. Among the 16 nurses who recognized LvVF, 15 performed defibrillation, and 2 followed the guidelines for non-shockable rhythms. Conclusions: There is a need to introduce compulsory periodic training for the nursing staff to focus on recognizing rhythms associated with cardiac arrest and implementing procedures based on the 2015 ERC guidelines. http://dx.doi.org/10.1016/j.resuscitation.2017.08.150
e61
AP050 A statistics based teaching intervention to aid foundation doctors when discussing cardiopulmonary resuscitation (CPR) Mayurun Ramadas ∗ , Lubna Ghani, Ben Clark Imperial College School of Medicine, London, UK Purpose: The United Kingdom Foundation Programme (UKFPO) syllabus states a foundation doctor should be able to discuss why CPR is not appropriate [1]). Discussions and questions pertaining to CPR success rate and complications are an often challenging yet a vital part of medical practice [2]. We implemented a teaching intervention that aimed to equip Foundation doctors’ with key National Cardiac Arrest Audit (NCAA) statistical data [3] to help them field such questions. Materials and method: Prior to the teaching a survey was given to foundation doctors (n = 36). Subsequently, a mandatory teaching session was delivered for them. The session identified key cardiac arrest demographics, success rate and complications based on the latest resus council NCAA data and how to express this appropriately. This was followed up by an immediate evaluation survey. A three month follow up survey evaluated whether the workshop resulted in self-rated behaviour change and long term impact. It was emphasised in the session that a statistics approach to CPR discussions was optional and one out of a variety of approaches that could be used if doctors felt confident discussing the statistics involved. Results: Qualitative pre-session data clearly highlighted that foundation doctors face challenging questions and statements from patients and family about ‘CPR prognosis/statistics’. Immediate post-session evaluation revealed foundation doctors found the teaching to be relevant, interactive and helpful to their training using a 5-point Likert scale (mean = 4.6). The three month postsession questionnaire showed that 69% of foundation doctors used the NCAA statistics provided in the workshop in their clinical practice when discussing why CPR was not appropriate. The same proportion felt the workshop had increased their confidence when discussing why CPR is not appropriate. Conclusion: Our results show many foundation doctors are fielding challenging questions and statements from patients and relatives about CPR. A useful approach to answering such questions is by using evidence based statistical data based on national cardiac arrest data (NCAA). The teaching session equipped them with statistical data and communication strategies which they found relevant and helpful to their training. Moreover, long term impact and behavioural change was noted as the majority of foundation doctors were using the statistics provided to them in their clinical practice three months post session to help them explain with confidence why CPR was not appropriate. References [1].UKFPO. Foundation Programme Syllabus; 2017. Available at: http://www. foundationprogramme.nhs.uk/curriculum/Syllabus; Clinical care; End of Life. [2].Etheridge Z, Gatland E. When and how to discuss “do not resuscitate” decisions with patients. BMJ (Clin Res ed) 2015;350:h2640. [3].National Cardiac Arrest Audit (NCAA) 2015/2016, Resuscitation council UK.
http://dx.doi.org/10.1016/j.resuscitation.2017.08.151