Objective: The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality. Methods: Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/ AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback. At the end of each course, we recorded 1 minute of compression-only CPR. The primary end point was the difference in the percentage of compressions performed with correct depth. Results: There was a significant improvement in the percentage of compressions with correct depth in the groups receiving feedback compared to the other (NF v. LF, p = 0.022; NF v. SF, p = 0.005). This improvement was also present in the percentage of compressions with a complete chest recoil (71.7% in NF, 86.6% in SF, and 88.8% in LF; p < 0.001), compressions with the correct hand position (93.2% in NF, 98.2% in SF, and 99.3% in LF; p < 0.001), and in the Total CPR Score (79.4% in NF, 90.2% in SF, and 92.5% in LF; p < 0.001). There were no significant differences for all of the parameters between group SF and group LF. Conclusions: Real-time visual feedback improves laypersons' CPR quality, and we suggest its use in every BLS/AED course for laypersons because it can help achieve the goals emphasized by the International Liaison Committee on Resuscitation recommendations. RÉSUMÉObjectif: Les chances de survie à la suite d'un arrêt cardiaque survenu dans la collectivité dépend de la rapidité des manoeuvres de réanimation cardiorespiratoire (RCR) ainsi que de leur qualité. L'étude décrite ici visait à vérifier si l'utilisation de dispositifs de rétroaction durant la formation des profanes en la matière pouvait améliorer la qualité des compressions thoraciques. Méthode: Ont participé à des cours de réanimation de base et de défibrillation 450 profanes en la matière, divisés au hasard en trois groupes : le premier a suivi le cours sans rétroaction (SR) aucune; le deuxième a suivi le cours avec une brève rétroaction (BR), soit 1 minute de formation avec une rétroaction visuelle en temps réel; et le troisième a suivi le cours avec une longue rétroaction (LR), soit 10 minutes de formation avec une rétroaction visuelle en temps réel. À la fin de chacun des cours, il y a eu enregistrement des compressions seules durant 1 min. Le principal critère d'évaluation était les différences de pourcentage quant aux compressions réalisées à la bonne profondeur. Résultats: Une amélioration sensible du pourcentage des compressions réalisées à la bonne profondeur a été observée dans les groupes dans lesquels il y avait eu de la rétroaction comparativement à celui qui n'en avait pas reç...

During extracorporeal membrane oxygenation (ECMO), oxygen (O) transfer (V'O) and carbon dioxide (CO) removal (V'CO) are partitioned between the native lung (NL) and the membrane lung (ML), related to the patient's metabolic-hemodynamic pattern. The ML could be assimilated to a NL both in a physiological and a pathological way. ML O transfer (V'OML) is proportional to extracorporeal blood flow and the difference in O content between each ML side, while ML CO removal (V'COML) can be calculated from ML gas flow and CO concentration at sweep gas outlet. Therefore, it is possible to calculate the ML gas exchange efficiency. Due to the ML aging process, pseudomembranous deposits on the ML fibers may completely impede gas exchange, causing a "shunt effect", significantly correlated to V'OML decay. Clot formation around fibers determines a ventilated but not perfused compartment, with a "dead space effect", negatively influencing V'COML. Monitoring both shunt and dead space effects might be helpful to recognise ML function decline. Since ML failure is a common mechanical complication, its monitoring is critical for right ML replacement timing and it also important to understand the ECMO system performance level and for guiding the weaning procedure. ML and NL gas exchange data are usually obtained by non-continuous measurements that may fail to be timely detected in critical situations. A real-time ECMO circuit monitoring system therefore might have a significant clinical impact to improve safety, adding relevant clinical information. In our clinical practise, the integration of a real-time monitoring system with a set of standard measurements and samplings contributes to improve the safety of the procedure with a more timely and precise analysis of ECMO functioning. Moreover, an accurate analysis of NL status is fundamental in clinical setting, in order to understand the complex ECMO-patient interaction, with a multi-dimensional approach.

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Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH2O, p = 0.012), driving pressure (11 vs. 8 cmH2O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (VT/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH2O, p = 0.048) and VT/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO.