ECSS Paris 2023: OP-MH13
INTRODUCTION: The posture and position of rescuers, as well as the height at which a patient is positioned during chest compressions, significantly influence the efficacy and efficiency of cardiopulmonary resuscitation (CPR). Despite this, there are no established guidelines regarding optimal rescuer posture or patient height placement, highlighting the need to systematize existing knowledge and explore the potential benefits of exercise interventions on CPR performance. This systematic review aims to evaluate the impact of rescuers posture and the height at which a patient or manikin is positioned during chest compressions. It focuses on mechanical and physiological fatigue indicators to determine how these factors affect the efficacy and efficiency of CPR. METHODS: Adhering to PRISMA guidelines and registered with PROSPERO, the review included peer-reviewed articles that compared different rescuer postures and patient heights during chest compressions. Databases such as MEDLINE Complete, SPORTDiscus, Cochrane Reviews, and CINAHL Complete were searched. The methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. RESULTS: The search yielded 6543 articles, with 34 meeting inclusion criteria. All studies were observational, utilized manikins, and were deemed weak in methodological quality. No studies specifically addressed exercise intervention impacts. The kneeling posture was found to enhance the efficacy and efficiency of chest compressions compared to standing, particularly when performed on the ground rather than a bed. Research on optimal patient height relative to rescuer anthropometrics remains scarce. The contact hand does not significantly impact compression quality, and chest compressions should not be performed while moving. CONCLUSION: The review found no studies on exercise interventions effects on CPR efficiency. There are no specific recommendations for rescuer posture based on patient height. Fitness levels may influence the duration of effective chest compressions, as physical function, muscle strength, mass and morphology tend to decline with age. Understanding physiological effort and recovery could optimize CPR techniques. Future research should investigate how exercise programs can affect CPR efficiency and fatigue in first aiders.
Read CV José Pedro MorgadoECSS Paris 2023: OP-MH13
INTRODUCTION: Elite sporting organizations in the Western world advocate cardiac screening to mitigate sudden cardiac death (SCD) risks. Data relating to the diagnostic yield of such programmes in sport are dominated by male athletes. Soccer is associated with the highest prevalence of SCD among young male athletes. A previous study on 11,168 soccer players, primarily males, revealed a 0.38% prevalence of cardiac disorders associated with SCD, and a 2% prevalence of minor cardiac disorders. The aim of this study was to investigate the prevalence of serious cardiac diseases and subsequent outcomes amongst female soccer players in the UK. We also report ECG and echocardiogram characteristics in this previously underreported population. METHODS: From 2000 to 2024, 3,121 female soccer players underwent the English FA cardiac screening programme, which comprised a health questionnaire, physical examination, 12-lead ECG, and transthoracic echocardiogram. The FA registry was reviewed for cardiac morbidity and SCD over a 6.8-year follow-up period. ECG and echocardiogram characteristics compared. RESULTS: Athletes had a mean age of 19.8 ± 5.4 years, with 749 (24%) aged 12–16 years, and 2,716 (87%) were white. 284 (9.1%) athletes reported one or more cardiac symptoms, and 165 (5.3%) required additional investigations. Six (0.2%) athletes were identified with significant cardiac disorders associated with SCD, and 33 (1.1%) had minor cardiac conditions. Over a follow-up of 5.0 ± 4.7 years (15,507 cumulative person-years), there were no cases of SCD, and one (0.03%) case of non-ischaemic cardiomyopathy. Compared with age- and ethnicity-matched male soccer players, females had lower rates of sinus bradycardia (39.1 vs 45.3%; p<0.001), sinus arrhythmia (15.0 vs 38.5%; p<0.001), left ventricular hypertrophy (8.7 vs 24.8%; p<0.001), and right ventricular hypertrophy (0.4% vs 2.3%; p<0.001), but a longer PR interval (150 ± 24 vs 140 ± 14 ms; p<0.001) and QTc interval (417 ± 26 vs 398 ± 16 ms; p<0.001). T-wave inversion (TWI) was more common in females (13.4 vs 2.8%; p<0.001), with a distribution of 12.2% in anterior leads, 1.1% in inferior leads, and 0.2% in lateral leads. Echocardiography revealed smaller left ventricular diameters (47.3 ± 3.7 vs 52.4 ± 3.9 mm; p<0.001) and right ventricular diameters (34.0 ± 5.2 vs 36.6 ± 4.8 mm; p<0.001) in females compared to males. CONCLUSION: Despite more frequent cardiac symptoms in female athletes, the occurrence of life-threatening conditions was lower compared to males. Electrical diseases were the most common significant cardiac disorders, and no cases of sudden cardiac arrest were recorded during the six-year follow-up.
Read CV Kentaro YamagataECSS Paris 2023: OP-MH13
INTRODUCTION: Pre-participation physical evaluation (PPE) is critical in reducing the risk of Sudden Cardiac Death in athletes and healthy individuals (1, 2). In Italy, PPE is mandatory for sport practice, and it usually includes anamnesis, electrocardiogram (ECG), it may include spirometry, and echocardiogram. In other countries, such as the USA, PPE mainly includes medical history and physical examination, excluding ECG(2). However, it is still disputed whether adding ECG to PPE is cost-effective. Over the past two decades, significant advancements in data digitalization and availability have led to the widespread adoption of Machine Learning (ML) algorithms in various fields. Supervised ML has shown excellent results in identifying follow-up recommendations(3). This study aimed to compare two supervised ML models, one using anamnesis data (Anamnesis_Model) and a second ECG data (ECG_Model), to evaluate their efficacy in identifying PPE medical examination follow-up need. METHODS: We used the PPE Cardarelli Campobasso Hospital database. From a total of 1116 subjects present in the database, 630 subjects were selected based on data completeness (i.e., competitive sport certificate). Data were preprocessed using the MissForest method to imputation residual missing values. Continuous variables were centered and scaled. Recursive feature elimination was applied to select the most relevant variables in both anamnesis and ECG case separately. The data set was divided into training (70%) and test sets (30%) and modeled using a logistic regression and k-fold crossvalidation (10-fold repeated 5 times). Accuracy, sensitivity, specificity of both models were compared. Data analysis and modeling were conducted in RStudio using caret package. RESULTS: Anamnesis_Model achieved a ROC AUC of 0.74 and setting sensitivity at 90% showed a specificity of 43% on the test set, with a balanced accuracy of 59.8%. ECG_Model outperformed Anamnesis_Model, achieving a ROC AUC of 0.79 and setting sensitivity at 90% showed a specificity of 70% with a balanced accuracy of 74.9%. CONCLUSION: PPE’s ECG information improved the prediction of medical examination follow-up need as set by the physician compared to anamnesis alone. These findings seem to be in favor of ECG inclusion in PPE. A major limitation of this study was not having access to follow-up examination’s results. References 1. Corrado, D. (2011) ‘Risk of sports: Do we need a pre-participation screening for competitive and leisure athletes?’, European Heart Journal, 32(8), pp. 934–944. 2. Corrado, D. (2005) ‘Cardiovascular pre-participation screening of young competitive athletes for prevention of Sudden death: Proposal for a common European protocol: Reply’, European Heart Journal, 26(17), pp. 1804– 1805 3. Carrodeguas, E., (2018) ‘Use of Machine Learning to Identify Follow-Up Recommendations in Radiology Reports’, Journal of the American College of Radiology: JACR, 16(3), 336.
Read CV Moira RaimoECSS Paris 2023: OP-MH13