Survival after out-of-hospital cardiac arrest (OHCA) depends on the immediate provision of high-quality bystander cardiopulmonary resuscitation (CPR) during the prehospital phase. In many community settings, repeated training opportunities are not guaranteed, making early attainment of guideline-consistent CPR skills during a single training exposure particularly important.

This study evaluated whether a scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-recommended chest compression metrics compared with conventional instruction.

A quasi-experimental study was conducted among medical students who received CPR instruction during two consecutive teaching periods (2014-2015, conventional instruction [CONV]; 2016-2017, simplified feedback-enabled kit [SIM]). Overall CPR performance was assessed at three pre-defined time points: pre-Basic Life Support (BLS), immediate post-BLS, and delayed follow-up (two-to-twelve months post-BLS). The primary outcome was attainment of the target compression rate (100-120 compressions/minute). Mixed-effects regression models were used to account for repeated measurements and to evaluate group × assessment interactions.

A total of 334 students were included: 171 in the CONV group and 163 in the SIM group. At the pre-BLS assessment, students in the SIM group demonstrated higher odds of achieving the target compression rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.13–5.71), target compression depth (OR, 2.65; 95% CI, 1.24–5.64), and complete chest recoil (OR, 1.71; 95% CI, 1.05–2.78). Mixed-effects modeling demonstrated that the between-group difference in target compression rate changed over time, with convergence observed at delayed follow-up.

A scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-consistent chest compression performance. These findings may support further evaluation of scalable feedback-enabled approaches in community-based or resource-limited training environments where repeated CPR instruction may not be feasible.

Dispatcher-guided cardiopulmonary resuscitation (CPR) via video calls represents an important shift from purely verbal instruction to real-time visual modeling for untrained bystanders during out-of-hospital cardiac arrest. This approach may improve compression depth, rhythm, overall CPR quality, and reduce interruptions.

Its implementation remains challenging because voice calls may be faster, whereas video guidance requires stable connectivity, smartphone access, digital literacy, appropriate camera positioning, and trained dispatchers. Moreover, simulation findings among young university students may not reflect real emergency conditions.

Video-assisted CPR should be developed as a hybrid, equitable, low-bandwidth intervention and tested pragmatically across diverse emergency systems.

The provision of instant telephone pre-arrival instructions (PAI) on first aid to laypeople by emergency services’ telecommunicators for conditions beyond cardiac arrest, such as trauma or acute coronary syndrome, is practiced by emergency services around the world and is recognized by some prehospital systems as a standard of care. However, to the best of the authors’ knowledge, no attempts have been made to date to systematically summarize the related research evidence.

The aim of this study was to systematically map and analyze published quantitative research on telecommunicator-assisted first aid (TAFA) for medical emergencies other than cardiac arrest.

Peer-reviewed journal papers reporting original quantitative data on experimental or real-world applications of TAFA were identified through PubMed, Scopus, and Google Scholar. Studies focusing solely on cardiac arrest management (cardiopulmonary resuscitation [CPR] or automated external defibrillation) were excluded. A scoping review of eligible papers was conducted in accordance with the PRISMA-ScR guidance.

Twenty-two studies published from 2000 through 2024 met inclusion criteria. First authors represented nine high-income countries. The studies investigated hypothetical or actual application of TAFA for anaphylaxis, chest pain or myocardial infarction, stroke, trauma, bleeding, childbirth, foreign body airway obstruction, opioid overdose, and respiratory arrest; four studies did not specify the type of emergency. Eight studies (36.4%) analyzed real Emergency Medical Services (EMS) call data, another eight (36.4%) were simulation-based, five (22.7%) used surveys, and one (4.5%) represented a cost-effectiveness analysis. The studies described existing TAFA practices, evaluated expectations and perceptions of the service by the public, demonstrated the feasibility of experimental techniques, including video communication, and identified areas for future investigations and interventions. Along with some beneficial effects of TAFA, several studies have demonstrated downsides of the practice, including suboptimal dispatcher adherence to pre-arrival protocols. The relationships between the real-world application of TAFA and patient outcomes are unclear.

According to the review of quantitative research, non-resuscitative TAFA remains an under-explored area of prehospital medicine. Considering the paucity and the inconclusiveness of available evidence, significantly more research is required to better understand its effects and practical implications. The evidence map generated by this scoping review may assist the professional community in advancing the development of non-resuscitative TAFA.

Nurses often serve as the initial responders in cases of cardiac arrest, making cardiopulmonary resuscitation (CPR) competence essential to effective resuscitation. It is therefore important for nursing students to possess sufficient CPR knowledge and skills for future clinical practice.

The aim of this study was to examine whether CPR post-qualification training is needed in maintaining knowledge and skills and if face-to-face or online training is more effective as an educational method in preserving CPR knowledge and skills in nursing students.

A three-group, parallel randomized-controlled, single-blind design was used. The participants were 133 nursing students, randomly assigned to the face-to-face group (n = 43), the e-learning group (n = 43), and the control group (n = 47). Before randomization, all participants (n = 133) successfully completed the European Resuscitation Council (ERC) standard five-hour Basic Life Support/Automated External Defibrillation (BLS/AED) course (t0) and a questionnaire based on the 2021 ERC Guidelines to assess their knowledge. Six months later, Group A received face-to-face training, Group B received e-learning training, and Group C had no intervention. Six months after interventions, all participants (n = 133) were re-assessed on the same questionnaire, and they were given the same scenario of cardiopulmonary arrest that was used during the initial BLS course to assess the skills that they retained (t1) with the use of the ERC CPR/AED 11-item checklist. The collected data were analyzed with inferential “among group” analysis involving Kruskal-Wallis’s and Pearson’s Chi-Squared test and inferential “within group” analysis including Wilcoxon’s Signed-Rank and McNemar’s test. Multiple linear regression was used for adjusting demographic characteristics.

Based on pairwise differences between independent groups, both intervention groups presented higher scores in knowledge at t1 (P < 0.001) and in skills at t1 (P < 0.001) compared to the control group. Moreover, both training methods demonstrated comparable effectiveness. Based on comparisons between paired groups, there was also a statistically significant decrease in the Skill Score in the control group after one year (P < 0.001). Most skills were notably higher, primarily in the e-learning group, and to a lesser extent in the face-to-face group. In specific, intervention groups demonstrated statistically significant improvement in nine of the eleven assessed skills (all P < 0.05).

The current study showed that post-qualification training is needed to retain CPR knowledge and skills of nursing students, and that face-to-face and e-learning training had similar outcomes.

Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality world-wide. Early bystander cardiopulmonary resuscitation (CPR) is a critical determinant of survival; however, many witnessed arrests are managed by untrained laypersons. Dispatcher-assisted CPR (DA-CPR) increases bystander intervention rates, but telephone-based guidance limits real-time assessment of compression quality. Video-assisted CPR (V-CPR) may overcome these limitations by enabling visual feedback and demonstration-based guidance.

The aim of this study was to evaluate whether video call-assisted dispatcher guidance incorporating simultaneous real-time demonstration improves CPR performance quality compared with voice call-assisted guidance in untrained laypersons during a simulated adult OHCA scenario.

This prospective, randomized, single-blind, manikin-based trial included 85 university students without prior CPR training. Participants were randomized to telephone-assisted CPR (T-CPR; n = 40) or video-assisted CPR (V-CPR; n = 45). All participants performed standardized hands-only CPR for five minutes following dispatcher instructions. In the V-CPR group, the dispatcher simultaneously demonstrated CPR on a manikin during the video call. The primary outcome was the composite CPR Quality Score generated by the manikin feedback system. Secondary exploratory outcomes included compression depth, compression rate, interruption time, and Emergency Medical Services (EMS)-related time intervals. Robust regression analysis adjusted for age, sex, dominant hand, height, and weight was performed.

The mean age of participants was 20.13 (SD = 1.81) years, and 54.1% were female. The CPR Quality Score was significantly higher in the V-CPR group than in the T-CPR group (median difference −47; 95% CI, −60 to −36; P < .001). The V-CPR group demonstrated greater mean compression depth, higher proportions of compressions within recommended rate and depth ranges, and shorter interruption times between compressions. The T-CPR group showed shorter time from case recognition to EMS call, while the interval from dispatcher contact to CPR initiation was similar between groups. In multivariable robust regression analysis, allocation to the V-CPR group remained independently associated with higher CPR Quality Score and improved compression performance metrics.

Video call-assisted dispatcher guidance incorporating simultaneous real-time visual demonstration significantly improves CPR quality in untrained lay rescuers compared with voice-only guidance. These findings suggest that structured visual modeling integrated into DA-CPR systems may enhance bystander resuscitation performance and help bridge gaps in community CPR training.

Bystander cardiopulmonary resuscitation (CPR) has been shown to be associated with increased rates of survival from non-traumatic out-of-hospital cardiac arrest (OHCA). GoodSAM is a platform integrated into the computer-assisted dispatch system. The software allows the telecommunicator to send a link to the caller’s smart phone. Once activated, the telecommunicator can see and hear the patient, and obtain breathing and heart rates using the camera and microphone on the caller’s phone. The telecommunicator can use the platform to identify cardiac arrest and provide real-time compression feedback. It was hypothesized that telecommunicator use of video telecommunication would be associated with increased rates of pre-arrival CPR.

This was a retrospective review of all cardiac arrest resuscitations performed from July 2021 through February 2022 in the San Antonio Fire Department (SAFD) Emergency Medical Services (EMS) system – the seventh largest city in the United States. Data source was the Office of the EMS Medical Director (OMD) Cardiac Arrest Registry. Inclusion criteria included cardiac arrests for which resuscitation was attempted. Exclusion criteria were cardiac arrest was witnessed by EMS personnel, or missing data. Dataset included: location of arrest, presumed etiology of the arrest, if dispatch CPR instructions were given; caller compliance; type of CPR performed; who witnessed the arrest; and who performed the CPR prior to EMS. Patients were dichotomized as to whether video telecommunication was used by the paramedic telecommunicator. A case was recorded as having received pre-arrival CPR if the initial CPR was performed by anyone other than the responding unit.

A total of 779 cases were included in the study. Primary outcome, in the cases where video telecommunication was utilized, 46/74 (62%) received pre-arrival CPR, versus 324/705 (46%) without the use of video telecommunication, with an overall difference of 16.2% (95% CI, 4.6% to 27.9%; P = .008). When using video telecommunication, a larger proportion of the persons performing pre-arrival CPR were family members when compared to the cases where video telecommunication was not used (35% versus 17%).

Using video telecommunication to perform paramedic clinical dispatch telemedicine was associated with an increased rate of pre-arrival CPR. Further research will be required to show outcome-related results to determine if dispatch video and audio telemedicine can be used to increase survival in patients suffering OHCA.

Many factors influence the likelihood of bystander cardiopulmonary resuscitation (BCPR) after out-of-hospital cardiac arrest (OHCA), but gender disparities in prehospital care remain under-examined, particularly in relation to the bystander’s connection to the patient.

The objective of this study was to evaluate the association between gender and the likelihood of receiving BCPR in OHCA. The primary outcome of the study was to examine differences in BCPR rates among men and women who experienced OHCA. The secondary outcome was to investigate whether bystanders were more likely to provide CPR based on their relationship to the victim, comparing “true” layperson CPR to CPR administered by family members or friends and how these rates differed between men and women.

This retrospective prehospital chart review included all encounters from a single urban Emergency Medical Services (EMS) agency with a cardiac arrest prior to EMS arrival from January 1, 2017 through June 30, 2022 (n = 701). For each encounter, the presence or absence of BCPR was recorded, along with the relation of the bystander to the patient. “True” BCPR was defined as CPR performed by a layperson unknown to the patient. Patients were excluded if they exhibited signs of obvious death, were physically inaccessible to bystanders, had CPR initiated by trained facility staff or police, had a do not resuscitate (DNR) order present on EMS arrival, received CPR but were not in cardiac arrest, or were younger than 18 years old (n = 174). Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate data, with statistical significance defined at P < .05.

The study examined 701 cardiac arrest encounters: 250 female (35.7%) and 451 male (64.3%). Overall, men (n = 123; 27.3%) were more likely to receive BCPR than women (n = 48; 19.2%); OR = 1.58; 95%CI, 1.08-2.30; P = .02. Among those who received BCPR, women were significantly more likely to have received it from someone they knew (83.3% versus 65.9%; OR = 2.59; 95%CI, 1.11-6.04; P = .03) while men were more likely to receive “true” layperson BCPR.

This study identifies significant gender disparities in prehospital BCPR and highlights an association between the bystander’s relationship to the patient and the likelihood of intervention.

The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.

A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.

There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).

The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.

Fear of cardiac arrest among parents of infants with heart disease can cause stress and anxiety. Literature is scarce on the effects of cardiopulmonary resuscitation training (CPRt) on anxiety and stress of parents. We analysed the impact of CPRt on anxiety, stress, and comfort levels on parents of infants with heart disease.

Cardiopulmonary resuscitation (CPR) and choking relief manoeuvre (CRM) comfort level, Parental State-Trait Anxiety Inventory (STAI), and Parenting Stress Index (PSI) scores were prospectively collected pre-, immediately post-, and 3 months post-CPRt.

There were 97 participants: 80% (n = 78) mothers/grandmothers and 20% (n = 19) fathers. The mean (SD) age of participants was 28.7 (5.6) years old. There was a significant decrease in STAI across the three time points collected; STAI decreased by 12% from baseline to immediately post-CPRt and 19% from baseline to 3 months post-CPRt (p < .0001). There were no significant changes in PSI across the time points. Baseline to immediately post-teaching, we found that CPRt significantly increased comfort performing CPR, CRM, and comfort in knowing what to do (p=< .001, p=< .001, p=< .001, respectively). Comfort levels persisted elevated when comparing pre- to 3 months post-CPRt (p=< .001, p= .002, p= .001, respectively), maintaining at least a 177% average increase up to 3 months post-CPRt for all aspects.

CPRt can aid in improving anxiety and comfort levels of parents of infants with heart disease around hospital discharge. Parental preparedness and reassurance to know what to do in emergency situations can be enhanced by a simple intervention such as CPRt.

Following the 2020 cardiopulmonary resuscitation (CPR) guidelines, this study compared participant’s fatigue with the quality of manual chest compressions performed in the head-up CPR (HUP-CPR) and supine CPR (SUP-CPR) positions for two minutes on a manikin.

Both HUP-CPR and SUP-CPR were performed in a randomized order determined by a lottery-style draw. Manual chest compressions were then performed continuously on a realistic manikin for two minutes in each position, with a 30-minute break between each condition. Data were collected on heart rate, blood pressure, and Borg rating of perceived exertion (RPE) scale scores from the participants before and after the compressions.

Mean chest compression depth (MCCD), mean chest compression rate (MCCR), accurate chest compression depth ratio (ACCDR), and correct hand position ratio were significantly lower in the HUP group than that in the SUP group. However, there were no significant differences in accurate chest compression rate ratio (ACCRR), correct recoil ratio, or mean arterial pressure (MAP) before and after chest compressions between the two groups. Changes in heart rate and RPE scores were greater in the HUP group.

High-quality manual chest compressions can still be performed when the CPR manikin is placed in the HUP position. However, the quality of chest compressions in the HUP position was poorer than those in the SUP position, and rescuer fatigue was increased.

Passive oxygenation with non-rebreather face mask (NRFM) has been used during cardiac arrest as an alternative to positive pressure ventilation (PPV) with bag-valve-mask (BVM) to minimize chest compression disruptions. A dual-channel pharyngeal oxygen delivery device (PODD) was created to open obstructed upper airways and provide oxygen at the glottic opening. It was hypothesized for this study that the PODD can deliver oxygen as efficiently as BVM or NRFM and oropharyngeal airway (OPA) in a cardiopulmonary resuscitation (CPR) manikin model.

Oxygen concentration was measured in test lungs within a resuscitation manikin. These lungs were modified to mimic physiologic volumes, expansion, collapse, and recoil. Automated compressions were administered. Five trials were performed for each of five arms: (1) CPR with 30:2 compression-to-ventilation ratio using BVM with 15 liters per minute (LPM) oxygen; continuous compressions with passive oxygenation using (2) NRFM and OPA with 15 LPM oxygen, (3) PODD with 10 LPM oxygen, (4) PODD with 15 LPM oxygen; and (5) control arm with compressions only.

Mean peak oxygen concentrations were: (1) 30:2 CPR with BVM 49.3% (SD = 2.6%); (2) NRFM 47.7% (SD = 0.2%); (3) PODD with 10 LPM oxygen 52.3% (SD = 0.4%); (4) PODD with 15 LPM oxygen 62.7% (SD = 0.3%); and (5) control 21% (SD = 0%). Oxygen concentrations rose rapidly and remained steady with passive oxygenation, unlike 30:2 CPR with BVM, which rose after each ventilation and decreased until the next ventilation cycle (sawtooth pattern, mean concentration 40% [SD = 3%]).

Continuous compressions and passive oxygenation with the PODD resulted in higher lung oxygen concentrations than NRFM and BVM while minimizing CPR interruptions in a manikin model.

Emergent resuscitation of postoperative paediatric cardiac surgical patients requires specialised skills and multidisciplinary teamwork. Bedside resternotomy is a rare but life-saving procedure and few studies focus on ways to prepare providers and improve performance. We created a multidisciplinary educational intervention that addressed teamwork and technical skills. We aimed to evaluate the efficiency of the intervention to decrease time to perform critical tasks and improve caregiver comfort.

A simulation-based, in situ resternotomy educational intervention was implemented. Pre-intervention data were collected. Educational aids were used weekly during day and night nursing huddles over a three-month period. All ICU charge nurses had separate educational sessions with study personnel and were required to demonstrate competency in all the critical tasks. Post-intervention simulations were performed after intervention and at 6 months and post-intervention surveys were performed.

A total of 186 providers participated in the intervention. There was a decrease in time to obtain defibrillator, setup resternotomy equipment and internal defibrillator paddles and deliver sedation and fluid (all p < 0.05). Time to escort family from the room and obtain blood was significantly decreased after intervention (p < 0.05). There was no difference in time to first dose of epinephrine, defibrillator pads on the patient, or time to call the cardiovascular surgeon or blood bank. Providers reported increased comfort in identifying equipment needed for resternotomy (p < 0.01) and setting up the internal defibrillator paddles (p < 0.01).

Implementation of a novel educational intervention increased provider comfort and decreased time to perform critical tasks in an emergent resternotomy scenario.