Recent discussions
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Roger Brock
I totally agree
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Federico Zaglia
I would support the implementation aiming for a routine use of at least posters.
We are currently doing so, to ensure adhesion to GGLL beyond the personal knowledge trained in simulation sessions.
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Julena Ardern
While I like the incision of DCC during resuscitation I can help but feel multiple different recommendations for different age groups is going to be confusing. As an NSL instructor the beauty of teaching the current algorithm is reinforcement through repetition. By introducing different methods of placental blood transfer for different gestations I believe that this will lead to mistakes, which can have adverse effects at the lower gestations. At present (in New Zealand) we teach infants <30 weeks being resuscitated in 30% FiO2, with lower pressures and use a thermal wrap. While some of the current evidence and associated recommendations are aimed at 28 weeks, it may be beneficial for pattern recognition to include this in the <30 week bundle of care.
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Zachary Davies
I believe that yes - OHCA patients should be taken to a cardiac arrest centre but only if one of the following criteria are met
- ROSC (if considering bypass then must be stable or be able to be managed until arrival at the centre)
- Higher likelihood of a good neurological outcome (i.e. a low MIRACLE2 score)
- Intra-arrest transport only if there is an obvious or highly likely cause of arrest that cannot be managed prehospital
- It is the closest receiving hospital
Similarly to regional trauma networks, there should be stringent bypass criteria, perhaps requiring oversight of a senior or specialist clinician.
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Robert Major
Patients presenting in a shockable rhythm OHCA,, who subsequently achieve ROSC, should be cared for in a cardiac centre. We have presented (EUSEM conference) retrospective observational data (for 2407 OHCA patients) showing Utstein patients have significantly lower mortality if taken direct to a cardiac centre post ROSC. We are publishing this work.
In geographical areas with longer journey times or less specialist centres going first to a cardiac centre will have survival benefits, In comparison to highly urban areas where transfers occur more easily and quickly to specialist hospitals. -
Federico Semeraro
Dear all,
I apologize for the multiple comments. I wasn’t recognized as the author in my first two comments.
Here are some additional references for your evaluation, specifically for the second part of the TR:
Alcázar Artero PM, Greif R, Cerón Madrigal JJ, Escribano D, Pérez Rubio MT, Alcázar Artero ME, López Guardiola P, Mendoza López M, Melendreras Ruiz R, Pardo Ríos M. Teaching cardiopulmonary resuscitation using virtual reality: A randomized study. Australas Emerg Care. 2023 Sep 2:S2588-994X(23)00055-6. doi: 10.1016/j.auec.2023.08.002. Epub ahead of print. PMID: 37666723.
Alcázar Artero PM, Pardo Rios M, Greif R, Ocampo Cervantes AB, Gijón-Nogueron G, Barcala-Furelos R, Aranda-García S, Ramos Petersen L. Efficiency of virtual reality for cardiopulmonary resuscitation training of adult laypersons: A systematic review. Medicine (Baltimore). 2023 Jan 27;102(4):e32736. doi: 10.1097/MD.0000000000032736. PMID: 36705392; PMCID: PMC9875948.
Best wishes
Federico Semeraro
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ILCOR Staff
Dear all,
Some references to take into account to review the second part of the Treatment Recommendations
We suggest against the use of virtual reality for basic and advanced life support training of laypeople and healthcare providers.In particular these two:
Semeraro F, Imbriaco G, Del Giudice D, Antognoli M, Celin D, Cuttitta M, Lo Guasto V, Giulini G, Gnudi T, Monesi A, Nava E, Tucci R, Carenzio A, Lo Jacono S, Gordini G, Gamberini L; Collaborators. Empowering the next Generation: An innovative "Kids Save Lives" blended learning programme for schoolchildren training. Resuscitation. 2023 Dec 13;194:110088. doi: 10.1016/j.resuscitation.2023.110088.
Chang YT, Wu KC, Yang HW, Lin CY, Huang TF, Yu YC, Hu YJ. Effects of different cardiopulmonary resuscitation education interventions among university students: A randomized controlled trial. PLoS One. 2023 Mar 14;18(3):e0283099. doi: 10.1371/journal.pone.0283099.
Plus:
1. Jaskiewicz F, Kowalewski D, Starosta K, Cierniak M, Timler D. Chest compressions quality during sudden cardiac arrest scenario performed in virtual reality: A crossover study in a training environment. Medicine (Baltimore). 2020 Nov 25;99(48):e23374. doi: 10.1097/MD.0000000000023374.
2. Sadeghi AH, Peek JJ, Max SA, Smit LL, Martina BG, Rosalia RA, Bakhuis W, Bogers AJ, Mahtab EA. Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study. JMIR Serious Games. 2022 Mar 2;10(1):e30456. doi: 10.2196/30456.
3. Buttussi F, Chittaro L, Valent F. A virtual reality methodology for cardiopulmonary resuscitation training with and without a physical mannequin. J Biomed Inform. 2020 Nov;111:103590. doi: 10.1016/j.jbi.2020.103590.
3. Semeraro F, Ristagno G, Giulini G, Gnudi T, Kayal JS, Monesi A, Tucci R, Scapigliati A. Virtual reality cardiopulmonary resuscitation (CPR): Comparison with a standard CPR training mannequin. Resuscitation. 2019 Feb;135:234-235. doi: 10.1016/j.resuscitation.2018.12.016.
4. Semeraro F, Ristagno G, Giulini G, Kayal JS, Cavallo P, Farabegoli L, Tucci R, Scelsi S, Grieco NB, Scapigliati A. Back to reality: A new blended pilot course of Basic Life Support with Virtual Reality. Resuscitation. 2019 May;138:18-19. doi: 10.1016/j.resuscitation.2019.02.034.
5. Semeraro F, Frisoli A, Bergamasco M, Cerchiari EL. Virtual reality enhanced mannequin (VREM) that is well received by resuscitation experts. Resuscitation. 2009 Apr;80(4):489-92. doi: 10.1016/j.resuscitation.2008.12.016. -
Fabio Stroppa
This is a very limited point of view. The opportunities in terms of research and development with VR are enormous, and many different types of applications can be made to serve the purpose of helping people. Specifically on CPR, it can be used to recreate immersive environments for serious games and training, which is helpful and scientifically validated by many studies in healthcare and rehabilitation. These devices are also very accurate: studies have shown that the tracking error of Oculus Quest 2 HMD over static measurement is 0.06 mm (Holzwarth, V., Gisler, J., Hirt, C., & Kunz, A. (2021, March). Comparing the accuracy and precision of steamvr tracking 2.0 and oculus quest 2 in a room scale setup. In 2021 the 5th International conference on virtual and Augmented Reality Simulations (pp. 42-46)). Although these devices cannot replace the performance of a mechanical/compliant manikin, they are less expensive (100$ vs 2000$ on average); therefore, it is easy to share technology with people at home that have a limited budget and still want to learn proper CPR.
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ILCOR Staff
Dear all,
Congratulations on your systematic review. Your analysis provides a comprehensive overview of the current evidence regarding immersive technologies in resuscitation education. However, considering some additional points and recent evidence before drawing a definitive conclusion might be beneficial.
Recent Advancements in VR/AR Technologies: The VR and AR fields are rapidly evolving. Newer studies may have incorporated more advanced technologies, potentially addressing some limitations identified in earlier research.
Variability in Study Design and Implementation: The significant heterogeneity in study designs, control groups, and interventions, as noted in your analysis, suggests that some observed limitations might stem from these variables rather than the VR/AR technologies themselves.
Different Learning Styles and Environments: VR and AR cater to diverse learning styles, providing immersive and interactive experiences that could be more effective for certain learners.
Long-term Skill Retention and Transferability: While immediate knowledge acquisition and skill performance are important, the long-term retention of these skills and their transferability to real-world scenarios are crucial.
Cost-Effectiveness and Accessibility: The cost and accessibility of VR/AR technologies are significant factors in their adoption. With technological advancements, these modalities might become more affordable and accessible, making them viable options for a broader range of training environments.
Complementary Role of VR/AR in Training: Viewing VR/AR as complementary to traditional methods, rather than standalone training tools, might be more appropriate. This blended approach could leverage the strengths of each modality.
Participant Feedback and Engagement: Participant feedback, particularly regarding engagement and motivation during training, is an important consideration. Recent studies focusing on these subjective aspects could provide a more holistic view of the effectiveness of VR/AR training.
In light of these considerations, suggesting against the use of VR/AR in life support training might be premature.
I have sent another comment with some references not included in your review, based on personal experience, which could be potentially useful for your consideration.
Thank you in advance for further evaluating this additional content.
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Jacob Jentzer
If any guidance can be provided about patients who are more or likely to benefit from ECPR, that would be helpful. For instance, my understanding is that most of the good outcomes with ECPR occur in patients with witnessed shockable rhythms. As written, this suggests that anyone could get ECPR when the evidence suggesting benefit is quite weak for unselected patients.