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Ma W, Liu E, Xiao L, Song Y, Zhou L, Zhang C, Deng H. The development and accuracy assessment of a wearable cardiopulmonary resuscitation real-time audio-visual feedback device. Resuscitation 2025; 211:110602. [PMID: 40189127 DOI: 10.1016/j.resuscitation.2025.110602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 03/13/2025] [Accepted: 03/29/2025] [Indexed: 04/20/2025]
Abstract
To enhance the quality of chest compressions and survival rates from cardiac arrest, several real-time audio-visual feedback devices have been developed. However, many of these feedback devices have certain issues regarding their usage or effectiveness. In this paper, we report on a wearable cardiopulmonary resuscitation real-time audio - visual feedback device, which is crafted with liquid silicone material for the casing to minimize skin injury. The device can display compression data (depth and frequency) in real-time and provides feedback through three forms of prompts. It has been evaluated for the accuracy of depth and frequency measurements against a reference device. The experimental results indicate that this wearable feedback device can provide more accurate depth and frequency data, holding the potential to become a tool for safely and effectively guiding high-quality cardiopulmonary resuscitation.
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Affiliation(s)
- Wenwen Ma
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, China
| | - Enze Liu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, China
| | - Landan Xiao
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, China
| | - Yuanwen Song
- Department of Electronic Information Engineering, South-Central Minzu University, China
| | - Liangyuan Zhou
- Department of Circuits and Systems, Northwest Normal University, China
| | - Chen Zhang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, China
| | - Huisheng Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, China.
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Mok G, Vaillancourt S, Fu M, Gray S, Chartier LB, Wong N, Allan KS, Warsi F, Callender C, McGowan M, Petrosoniak A. Implementation of a CPR quality data collection program in the emergency department: a quality improvement initiative. CAN J EMERG MED 2025; 27:451-459. [PMID: 40053313 DOI: 10.1007/s43678-025-00882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/02/2025] [Indexed: 06/18/2025]
Abstract
OBJECTIVES We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024. METHODS The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review© was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims. RESULTS CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s. CONCLUSION Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.
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Affiliation(s)
- Garrick Mok
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Samuel Vaillancourt
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Minnie Fu
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Gray
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Lucas B Chartier
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Natalie Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Katherine S Allan
- Division of Cardiology, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Management, and Evaluation, Institute of Health Policy, University of Toronto, Toronto, ON, Canada
| | - Farah Warsi
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Celine Callender
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Melissa McGowan
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew Petrosoniak
- Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Kohli SK, Dhurve G, Mohammad KG, Khan TA, Yusuf M. The power of small RNAs: A comprehensive review on bacterial stress response and adaptation. Int J Biol Macromol 2025; 315:144411. [PMID: 40398788 DOI: 10.1016/j.ijbiomac.2025.144411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 05/13/2025] [Accepted: 05/18/2025] [Indexed: 05/23/2025]
Abstract
Bacteria employ a wide range of RNA-based regulatory systems to adapt to various environmental stressors. Among these, small non-coding RNAs (sRNAs) have emerged as critical regulators of gene expression. These compact RNA molecules modulate numerous cellular functions, including stress adaptation, biofilm development, and virulence. By acting primarily at the post-transcriptional level, sRNAs enable bacteria to swiftly adjust gene expression in response to external challenges. One key mechanism of sRNA action is translational repression, which includes the regulation of toxin-antitoxin systems pathways essential for bacterial persistence and antibiotic resistance. Additionally, sRNAs orchestrate the expression of genes involved in biofilm formation, enhancing surface adhesion, extracellular matrix production, and resistance to antimicrobial agents. Bacterial outer membrane vesicles (OMVs) also play a significant role in stress adaptation and intercellular communication. These vesicles transport a complex cargo of proteins, lipids, and nucleic acids, including sRNAs. The transfer of sRNAs through OMVs can modulate the physiology of neighboring bacterial cells as well as host cells, highlighting their role in cross-kingdom signaling. sRNAs serve as versatile and potent regulatory elements that support bacterial survival under hostile conditions. Advancing our understanding of sRNA-mediated networks offers promising avenues for uncovering bacterial pathogenesis and developing innovative antimicrobial therapies.
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Affiliation(s)
- Sukhmeen Kaur Kohli
- Department of Earth and Climate Sciences (ECS), Indian Institute of Science Education and Research (IISER) Tirupati, Tirupati, Andhra Pradesh, India
| | - Ganeshwari Dhurve
- Department of Animal Biology, School of Life Science, University of Hyderabad, Hyderabad 500046, Telangana, India
| | - Kashif Gulam Mohammad
- Department of Animal Biology, School of Life Science, University of Hyderabad, Hyderabad 500046, Telangana, India
| | - Tanveer Alam Khan
- Department of Biology, College of Science, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Mohammad Yusuf
- Department of Biology, College of Science, United Arab Emirates University, Al Ain 15551, United Arab Emirates.
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Ishoso D, Mafuta E, Bettinger K, Bose C, Chi BH, Haug I, Gomez P, Eilevstjønn J, McRea A, Myklebust H, Tshefu A, Patterson JK. Preclinical usability evaluation of the Liveborn app: A mobile health application that provides feedback for neonatal resuscitation. PLOS DIGITAL HEALTH 2025; 4:e0000814. [PMID: 40267078 PMCID: PMC12017530 DOI: 10.1371/journal.pdig.0000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 03/05/2025] [Indexed: 04/25/2025]
Abstract
Neonatal mortality, particularly due to failure to breathe at birth, remains a significant challenge in low- and middle-income countries (LMICs). Effective neonatal resuscitation is essential to improving survival, but is challenging to implement consistently at the bedside. The Liveborn mobile health application for newborn resuscitation was developed to provide real-time guidance and support debriefing for healthcare workers in LMICs. Liveborn allows an observer to document the timing of key actions during a resuscitation; it then compares the observer data to recommended care and provides data-driven feedback. This study aimed to evaluate the usability of Liveborn in simulated resuscitations. We conducted two rounds of simulated resuscitations using Liveborn with midwives at one health facility in the Democratic Republic of Congo. Each round included ten simulations, with half testing real-time guidance and half focusing on debriefing. Between rounds, Liveborn was iteratively refined based on analysis of video-recordings of the simulations and participant surveys. Midwives' perceptions of usability and feasibility were assessed using previously validated survey tools including the System Usability Scale (SUS) with a score >68 considered above average, and the Feasibility of Intervention Measure (FIM) with a score >12 considered above neutral. Round 1 of testing identified several key usability issues including difficulty accurately recording events, poor adherence to audio guidance that was insufficiently specific, and poor flow of debriefing for intrapartum stillbirth cases. The Liveborn app, after iterative refinement, demonstrated excellent usability (median SUS score of 90 [Q1, Q3: 85, 95]) and excellent feasibility (median FIM score of 19 [16, 20]). Further research is needed to assess Liveborn's effectiveness in real clinical settings and its impact on neonatal outcomes in LMICs.
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Affiliation(s)
- Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Kourtney Bettinger
- Department of Pediatrics, University of Kansas, Kansas City, Kansas, United States of America
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Benjamin H. Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | | | - Abigail McRea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Asan H, Çevik E, Yıldırım K, Güngör AC, İlhan A, Satılmış D. Comparison of different surfaces in resuscitation quality using a real-time feedback device: A manikin study. Turk J Emerg Med 2025; 25:17-24. [PMID: 39882092 PMCID: PMC11774430 DOI: 10.4103/tjem.tjem_100_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 01/31/2025] Open
Abstract
OBJECTIVES Delivering chest compressions (CCs) at the targeted depth and rate is a crucial aspect of maintaining the quality of cardiopulmonary resuscitation (CPR). Although administering CCs on a firm surface is recommended, it may not always be feasible. This study aimed to determine whether the underlying surface affects CC depth and rate using a real-time feedback device. METHODS An observational study was conducted on a manikin (ResusciAnne; Laerdal). 25 volunteer emergency medicine physicians performed 2 min of continuous CCs without feedback on the floor, emergency department stretcher (EDS), and ambulance stretcher (AS). The following day, all participants performed an additional 2 min of CCs while receiving audiovisual real-time feedback (ZOLL M2 series). Compression depths and rates were measured and recorded in a real-time feedback device. RESULTS A total of 150 CC intervals were analyzed. The mean values of compression depths and rates on all surfaces are within the targeted range for high-quality CPR, except for the mean depth without feedback on the EDS (mean: 6.37 cm). There were a statistically significant difference, with both AS and EDS were achieved deeper compressions than those on the floor (P < 0.05). When examining the mean compression depths on three different surfaces with feedback, no statistically significant difference was observed. However, CCs performed without feedback on both AS and EDS were statistically significantly deeper than those on the floor. The mean compression rates both on the floor and the AS were statistically significantly faster compared to EDS. When examining the mean compression rates during CCs performed on three different surfaces with feedback, no statistically significant difference was observed but in the without feedback compressions, both on AS and floor were found to be statistically significantly faster than EDS. CONCLUSIONS CC's depth are influenced by the underlying surface. It appears more feasible to minimize surface-related differences while maintaining appropriate targets for depth using real-time feedback devices. The mean compression rate could be kept within the targeted range regardless of the surface.
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Affiliation(s)
- Hande Asan
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
| | - Erdem Çevik
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
| | - Kemal Yıldırım
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
| | - Aydın Cenk Güngör
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
| | - Abdullah İlhan
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
| | - Dilay Satılmış
- Department of Emergency, University of Health Sciences, Sultan 2. Abdülhamid Han Research and Training Hospital, Istanbul, Türkiye
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Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ, Scholefield BR, Smyth M, Weiner G, Abelairas-Gómez C, Acworth J, Anderson N, Atkins DL, Berry DC, Bhanji F, Böttiger BW, Bradley RN, Breckwoldt J, Carlson JN, Cassan P, Chang WT, Charlton NP, Phil Chung S, Considine J, Cortegiani A, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Caen AR, Deakin CD, Debaty G, Del Castillo J, Dewan M, Dicker B, Djakow J, Donoghue AJ, Eastwood K, El-Naggar W, Escalante-Kanashiro R, Fabres J, Farquharson B, Fawke J, de Almeida MF, Fernando SM, Finan E, Finn J, Flores GE, Foglia EE, Folke F, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hansen CM, Hatanaka T, Hirsch KG, Holmberg MJ, Hooper S, Hoover AV, Hsieh MJ, Ikeyama T, Isayama T, Johnson NJ, Josephsen J, Katheria A, Kawakami MD, Kleinman M, Kloeck D, Ko YC, Kudenchuk P, Kule A, Kurosawa H, Laermans J, Lagina A, Lauridsen KG, Lavonas EJ, Lee HC, Han Lim S, Lin Y, Lockey AS, Lopez-Herce J, Lukas G, Macneil F, Maconochie IK, Madar J, Martinez-Mejas A, Masterson S, Matsuyama T, Mausling R, McKinlay CJD, Meyran D, Montgomery W, Morley PT, Morrison LJ, et alGreif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ, Scholefield BR, Smyth M, Weiner G, Abelairas-Gómez C, Acworth J, Anderson N, Atkins DL, Berry DC, Bhanji F, Böttiger BW, Bradley RN, Breckwoldt J, Carlson JN, Cassan P, Chang WT, Charlton NP, Phil Chung S, Considine J, Cortegiani A, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Caen AR, Deakin CD, Debaty G, Del Castillo J, Dewan M, Dicker B, Djakow J, Donoghue AJ, Eastwood K, El-Naggar W, Escalante-Kanashiro R, Fabres J, Farquharson B, Fawke J, de Almeida MF, Fernando SM, Finan E, Finn J, Flores GE, Foglia EE, Folke F, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hansen CM, Hatanaka T, Hirsch KG, Holmberg MJ, Hooper S, Hoover AV, Hsieh MJ, Ikeyama T, Isayama T, Johnson NJ, Josephsen J, Katheria A, Kawakami MD, Kleinman M, Kloeck D, Ko YC, Kudenchuk P, Kule A, Kurosawa H, Laermans J, Lagina A, Lauridsen KG, Lavonas EJ, Lee HC, Han Lim S, Lin Y, Lockey AS, Lopez-Herce J, Lukas G, Macneil F, Maconochie IK, Madar J, Martinez-Mejas A, Masterson S, Matsuyama T, Mausling R, McKinlay CJD, Meyran D, Montgomery W, Morley PT, Morrison LJ, Moskowitz AL, Myburgh M, Nabecker S, Nadkarni V, Nakwa F, Nation KJ, Nehme Z, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall G, Ohshimo S, Olasveengen T, Olaussen A, Ong G, Orkin A, Parr MJ, Perkins GD, Pocock H, Rabi Y, Raffay V, Raitt J, Raymond T, Ristagno G, Rodriguez-Nunez A, Rossano J, Rüdiger M, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer G, Schnaubelt S, Seidler AL, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Solevåg AL, Soll R, Stassen W, Sugiura T, Thilakasiri K, Tijssen J, Tiwari LK, Topjian A, Trevisanuto D, Vaillancourt C, Welsford M, Wyckoff MH, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP, Berg KM. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024; 150:e580-e687. [PMID: 39540293 DOI: 10.1161/cir.0000000000001288] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
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Breuer-Kaiser AFC, Lefering R, Weber TP, Gräsner JT, Wnent J. Use of CPR feedback devices to treat out-of-hospital cardiac arrest in Germany: Associated with improved ROSC-rates, but infrequent usage, in a registry-based analysis of 107,548 cases. Resuscitation 2024:110453. [PMID: 39645022 DOI: 10.1016/j.resuscitation.2024.110453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 11/17/2024] [Accepted: 11/28/2024] [Indexed: 12/09/2024]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest is a leading cause of mortality in Europe. Quality cardiopulmonary resuscitation, particularly of chest compressions, is crucial. Real-time audiovisual feedback (RTAVF) devices aim to enhance chest compression quality. Recent studies on these tools have reported improved outcomes for in-hospital but not for out-of-hospital cardiac arrest. This registry-based, retrospective study investigated the use of feedback-devices by emergency medical services personnel to treat out-of-hospital cardiac arrest in Germany and assessed its effect on return of spontaneous circulation (ROSC). METHODS We analyzed 107,548 records from the German Resuscitation Registry between 2015 and 2022 and compared patient outcomes of patients treated with feedback devices or not. ROSC rates both at any time and at hospital admission were compared to expected rates based on the "Rosc After Cardiac Arrest" (RACA) score. Furthermore, a generalized linear mixed methods model was calculated to receive an adjusted effect for those devices. RESULTS Feedback-devices were used in 17.5% of cases overall, rising from 7.1% (2015) to 23.2% (2022). Patients resuscitated with feedback devices had a 2.6% higher rate of hospital admission with spontaneous circulation (35.9% vs. 33.3%). In both groups, the ROSC rates were higher than predicted by the RACA score. After multivariable adjustment we found a minor effect for RTAVF use on any ROSC (odds ratio 1.09, 95% confidence interval 1.04-1.14), but no effect on the ROSC rate on admission (odds ratio 0.98, 95% confidence interval 0.93-1.03). CONCLUSION We could show a minor association between the use of feedback devices and any ROSC, but not for ROSC on hospital admission, in out-of-hospital cardiac arrest patients in a generalized linear mixed model. Further research should address implementation strategies, sustainability and evaluate its effectiveness for other applications.
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Affiliation(s)
| | - Rolf Lefering
- University Witten/Herdecke, Institute for Research in Operative Medicine (IFOM), Ostmerheimer Str. 200, Haus 38, 51109 Köln, Germany.
| | - Thomas Peter Weber
- Ruhr-University Bochum, Department of Anesthesiology and Intensive Care Medicine, University Hospital St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany.
| | - Jan-Thorsten Gräsner
- University Hospital Schleswig-Holstein. Institute for Emergency Medicine, Arnold-Heller-Str. 3, Haus 808, 24105 Kiel, Germany; German Resuscitation Registry, German Society for Anesthesiology and Intensive Care Medicine, Neuwieder Str. 9, 90411 Nürnberg, Germany; University Hospital Schleswig-Holstein. Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
| | - Jan Wnent
- University Hospital Schleswig-Holstein. Institute for Emergency Medicine, Arnold-Heller-Str. 3, Haus 808, 24105 Kiel, Germany; German Resuscitation Registry, German Society for Anesthesiology and Intensive Care Medicine, Neuwieder Str. 9, 90411 Nürnberg, Germany; University Hospital Schleswig-Holstein. Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
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Liu Q, Li B, Zhou S, Gu L, Xue L, Lu R, Xu L, Sun P. The effect of hand and body position on chest compression quality and rescuer fatigue in prone cardiopulmonary resuscitation. Resusc Plus 2024; 20:100787. [PMID: 39431049 PMCID: PMC11490737 DOI: 10.1016/j.resplu.2024.100787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/22/2024] Open
Abstract
Aim This study aimed to compare the quality of compressions in supine cardiopulmonary resuscitation (CPR) and prone CPR by performing chest compressions on a manikin. Evaluating the effect of prone CPR using different hand and body position on the quality of manual chest compressions and fatigue of participants. Methods After completing 2 min of chest compression in the supine position (Supine Group), 25 participants randomly performed three sets of 2-minutes chest compressions on a prone position manikin. Stand + hands overlapped Group: participants stood beside the patient bed with their hands overlapped and placed on the posterior segment of the thoracic spine between the scapulae, Straddle + hands separated Group: participants straddled the patient bed with their hands placed above the scapulae on both sides at the mid-chest level, and Straddle + hands overlapped Group: participants straddled the patient bed with their hands overlapping on the posterior segment of the thoracic spine between the scapulae. Subsequently, the quality of chest compressions and participants fatigue were assessed. Results Chest compression depth ratio and mean chest compression depth (MCCD) were worse in the three prone CPR groups (Stand + hands overlapped Group: 0.0(0.0,15.6) %, 39.8 ± 1.3 mm; Straddle + hands separated Group: 1.4(0.0,11.7) %, 42.4 ± 1.2 mm; Straddle + hands overlapped Group: 0.0(0.0,9.2) %, 40.9 ± 1.2 mm) than in the Supine group (87.1(68.1,94.0) %; p < 0.001, 52.4 ± 0.4 mm; p < 0.001). In the three prone CPR groups, Straddle + hands separated Group had the greatest MCCD, lowest changes in heart rate (p = 0.018) and lowest changes in RPE scores (p < 0.001). There were no significant differences between the four groups in terms of mean chest compression rate, accurate chest compression rate ratio, or correct recoil ratio. Conclusion This simulation-based study showed that the quality of chest compressions was worse in the prone position than in the supine position. When prone chest compressions were performed using different hand and body position, prone CPR performed by a participant straddling a hospital bed with hands placed above the scapula on either side at the mid-chest level provided higher-quality chest compressions and lower rescuer fatigue.
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Affiliation(s)
| | | | - Siyi Zhou
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei Province 430022, China
| | - Lulu Gu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei Province 430022, China
| | - Letian Xue
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei Province 430022, China
| | - Ruyue Lu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei Province 430022, China
| | - Li Xu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei Province 430022, China
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Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ, Scholefield BR, Smyth M, Weiner G, Abelairas-Gómez C, Acworth J, Anderson N, Atkins DL, Berry DC, Bhanji F, Böttiger BW, Bradley RN, Breckwoldt J, Carlson JN, Cassan P, Chang WT, Charlton NP, Phil Chung S, Considine J, Cortegiani A, Costa-Nobre DT, Couper K, Bittencourt Couto T, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Caen AR, Deakin CD, Debaty G, Del Castillo J, Dewan M, Dicker B, Djakow J, Donoghue AJ, Eastwood K, El-Naggar W, Escalante-Kanashiro R, Fabres J, Farquharson B, Fawke J, Fernanda de Almeida M, Fernando SM, Finan E, Finn J, Flores GE, Foglia EE, Folke F, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Malta Hansen C, Hatanaka T, Hirsch KG, Holmberg MJ, Hooper S, Hoover AV, Hsieh MJ, Ikeyama T, Isayama T, Johnson NJ, Josephsen J, Katheria A, Kawakami MD, Kleinman M, Kloeck D, Ko YC, Kudenchuk P, Kule A, Kurosawa H, Laermans J, Lagina A, Lauridsen KG, Lavonas EJ, Lee HC, Han Lim S, Lin Y, Lockey AS, Lopez-Herce J, Lukas G, Macneil F, Maconochie IK, Madar J, Martinez-Mejas A, Masterson S, Matsuyama T, Mausling R, McKinlay CJD, Meyran D, Montgomery W, Morley PT, Morrison LJ, et alGreif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ, Scholefield BR, Smyth M, Weiner G, Abelairas-Gómez C, Acworth J, Anderson N, Atkins DL, Berry DC, Bhanji F, Böttiger BW, Bradley RN, Breckwoldt J, Carlson JN, Cassan P, Chang WT, Charlton NP, Phil Chung S, Considine J, Cortegiani A, Costa-Nobre DT, Couper K, Bittencourt Couto T, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Caen AR, Deakin CD, Debaty G, Del Castillo J, Dewan M, Dicker B, Djakow J, Donoghue AJ, Eastwood K, El-Naggar W, Escalante-Kanashiro R, Fabres J, Farquharson B, Fawke J, Fernanda de Almeida M, Fernando SM, Finan E, Finn J, Flores GE, Foglia EE, Folke F, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Malta Hansen C, Hatanaka T, Hirsch KG, Holmberg MJ, Hooper S, Hoover AV, Hsieh MJ, Ikeyama T, Isayama T, Johnson NJ, Josephsen J, Katheria A, Kawakami MD, Kleinman M, Kloeck D, Ko YC, Kudenchuk P, Kule A, Kurosawa H, Laermans J, Lagina A, Lauridsen KG, Lavonas EJ, Lee HC, Han Lim S, Lin Y, Lockey AS, Lopez-Herce J, Lukas G, Macneil F, Maconochie IK, Madar J, Martinez-Mejas A, Masterson S, Matsuyama T, Mausling R, McKinlay CJD, Meyran D, Montgomery W, Morley PT, Morrison LJ, Moskowitz AL, Myburgh M, Nabecker S, Nadkarni V, Nakwa F, Nation KJ, Nehme Z, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall G, Ohshimo S, Olasveengen T, Olaussen A, Ong G, Orkin A, Parr MJ, Perkins GD, Pocock H, Rabi Y, Raffay V, Raitt J, Raymond T, Ristagno G, Rodriguez-Nunez A, Rossano J, Rüdiger M, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer G, Schnaubelt S, Lene Seidler A, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Lee Solevåg A, Soll R, Stassen W, Sugiura T, Thilakasiri K, Tijssen J, Kumar Tiwari L, Topjian A, Trevisanuto D, Vaillancourt C, Welsford M, Wyckoff MH, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP, Berg KM. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 205:110414. [PMID: 39549953 DOI: 10.1016/j.resuscitation.2024.110414] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2024]
Abstract
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
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Gambolò L, Di Fronzo P, Ristagno G, Biserni S, Milazzo M, Socaci DM, Sarli L, Artioli G, Bonacaro A, Stirparo G. The Role of Different Feedback Devices in the Survival of Patients in Cardiac Arrest: Systematic Review with Meta-Analysis. J Clin Med 2024; 13:5989. [PMID: 39408049 PMCID: PMC11477487 DOI: 10.3390/jcm13195989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/29/2024] [Accepted: 10/06/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Cardiac arrest is a critical condition affecting approximately 1 in every 1000 people in Europe. Feedback devices have been developed to enhance the quality of chest compressions during CPR, but their clinical impact remains uncertain. This study aims to evaluate the effect of feedback devices on key clinical outcomes in adult patients experiencing both out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). The primary objective is to assess their impact on the return of spontaneous circulation (ROSC); secondary objectives include the evaluation of neurological status and survival to discharge. Methods: A systematic review was conducted following PRISMA guidelines, utilizing databases including PubMed, Scopus, Web of Science, and Embase. Studies published between 2000 and 2023 comparing CPR with and without the use of feedback devices were included. A fixed-effects network meta-analysis was performed for ROSC and survival, while a frequentist meta-analysis was conducted for neurological outcomes. Results: Twelve relevant studies met the inclusion criteria. The meta-analysis results showed that the use of audiovisual feedback devices significantly increases the likelihood of ROSC (OR 1.26, 95% CI 1.13-1.41, p < 0.0001) and survival (OR 1.52, 95% CI 1.27-1.81, p < 0.0001) compared to CPR without feedback. However, the effect of metronomes did not reach statistical significance. Conclusions: Feedback devices, particularly audiovisual ones, are associated with improved clinical outcomes in cardiac arrest patients. Their use should be encouraged in both training settings and real-life emergency scenarios to enhance survival rates and ROSC. However, further studies are needed to confirm long-term impacts and to explore the potential benefits of metronomes.
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Affiliation(s)
- Luca Gambolò
- SIMED—Società Italiana di Medicina e Divulgazione Scientifica, 43121 Parma, Italy
- Local Health Unit of Piacenza, Ospedale Guglielmo da Saliceto, 29122 Piacenza, Italy
| | - Pasquale Di Fronzo
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giuseppe Ristagno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università Degli studi di Milano, 20122 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Sofia Biserni
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Martina Milazzo
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Delia Marta Socaci
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Antonio Bonacaro
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giuseppe Stirparo
- SIMED—Società Italiana di Medicina e Divulgazione Scientifica, 43121 Parma, Italy
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AlSayed T, Haliq SA, Katbi F, Alghamdi M, Almulhim M. Does Real-time Feedback Guide Devices Improve the Quality of Chest Compressions in the Bystander (Naves) Provider? J Emerg Trauma Shock 2024; 17:221-224. [PMID: 39911463 PMCID: PMC11792752 DOI: 10.4103/jets.jets_35_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 02/07/2025] Open
Abstract
Introduction Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that must taught to everyone. As most cardiac arrests occur outside of the hospital, training the general population in the recognition of cardiac arrest and performing high-quality CPR is vital. Thus, this study aimed to compare the chest compression quality data (rate, depth, and fraction) with and without the use of feedback devices during CPR. Methods A crossover observational study was carried out at a tertiary hospital in September 2021. Five hundred and seventeen 1st-year university students were recruited, and the response rate was 90% (465). A feedback device was used to collect data. The data were numerically coded and statistical software (SPSS 21) was used to perform descriptive and inferential statistical analysis, including a paired t-test. Results The mean compression rate with feedback was statistically significantly lower after performing one cycle of CPR (mean difference: -5.610; 95% confidence interval [CI]= -7.987--3.233; P < 0.001), the difference between mean compression depth with and without feedback was not statistically significant (mean difference: = -0.006; 95% CI = -0.190-0.177; P = 0.944), and the mean compression target (%) with feedback was statistically significantly higher (mean difference: -15.951; 95% CI = -17.894--14.009; P < 0.001). Conclusions We found that the use of feedback devices during layperson-simulated CPR scenarios significantly improved the quality of chest compression in terms of depth and rate and resulted in more guidelines adherence. Moreover, national programs for CPR education should be implemented.
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Affiliation(s)
- Thamir AlSayed
- Department of Emergency Medicine, King Fahd Hospital of the University, Al Khobar, Dammam, Saudi Arabia
| | - Samer Al Haliq
- Department of Emergency Medical Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Katbi
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohannad Alghamdi
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Almulhim
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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12
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Masterson S, Norii T, Yabuki M, Ikeyama T, Nehme Z, Bray J, the BLS ILCOR Task Force. Real-time feedback for CPR quality - A scoping review. Resusc Plus 2024; 19:100730. [PMID: 39185285 PMCID: PMC11341937 DOI: 10.1016/j.resplu.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 08/27/2024] Open
Abstract
Background Previous systematic reviews have failed to find an association between the use of real-time feedback during cardiopulmonary resuscitation (CPR) and patient outcomes. However, these reviews excluded studies examining feedback with other system changes. As part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation process, we conducted a scoping review to examine the current state of this literature and the use of real-time feedback in this form. Methods/Data sources A protocol and search strategy was developed. We searched Medline, EMBASE, and Allied Health Literature (CINAHL) from inception to May 2024. Cochrane (Cochrane (specifically, the Cochrane Database of Systematic Reviews) is contained in Medline so was not searched separately. Studies were eligible for inclusion if they were published or unpublished (grey-literature) studies involving children or adults that examined the effect of real-time feedback or prompting on the quality of CPR following cardiac arrest. Data were extracted and audited independently. For each study, the following information were extracted: the author(s); year of publication; timeframe; study design; country; population; intervention and comparator; type of feedback or prompt; outcomes measured; main findings for CPR quality, and; main findings for patient outcomes. Reviewers also allocated key themes to each study and held a series of consensus discussions to consolidate themes across the included studies. Results We screened 2,657 titles and included 60 studies. Our analysis identified five overlapping themes in the extended literature: system change and quality improvement; impact on patient outcomes; better CPR quality without improved patient outcome; CPR feedback as a generator of other CPR metrics; and CPR feedback as a potential harm. Results revealed a substantial adjacent literature, particularly on implementing high-performance CPR as part of quality improvement programs. Conclusions This scoping review has identified a large body of literature and specific themes of interest in relation to feedback for CPR quality. Future systematic reviews should include studies examining real-time feedback with other system changes.
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Affiliation(s)
- Siobhán Masterson
- National Ambulance Service, Health Service Executive, Limerick, Ireland
- Discipline of General Practice, University of Galway, Ireland
- School of Medicine, University College Cork, Ireland
| | - Tatsuya Norii
- School of Medicine, University of New Mexico, Albuquerque, United States
| | - Mio Yabuki
- Faculty of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takaya Ikeyama
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children’s Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Australia
| | - the BLS ILCOR Task Force
- National Ambulance Service, Health Service Executive, Limerick, Ireland
- Discipline of General Practice, University of Galway, Ireland
- School of Medicine, University College Cork, Ireland
- School of Medicine, University of New Mexico, Albuquerque, United States
- Faculty of Medicine, Nippon Medical School, Tokyo, Japan
- Center for Pediatric Emergency and Critical Care Medicine, Aichi Children’s Health and Medical Center, Japan
- Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Japan
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Australia
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Yin RT, Berve PO, Skaalhegg T, Elola A, Taylor TG, Walker RG, Aramendi E, Chapman FW, Wik L. Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest. Resuscitation 2024; 201:110311. [PMID: 38992561 DOI: 10.1016/j.resuscitation.2024.110311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND AIMS Chest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest. METHODS We analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015-2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression. RESULTS We included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R2: 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively). CONCLUSIONS ABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration.
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Affiliation(s)
- Rose T Yin
- Stryker Emergency Care, Redmond, WA 98052, USA
| | - Per Olav Berve
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Doctor Car 119, Air Ambulance Department, Division of Prehospital Care, Oslo University Hospital, Oslo, Norway
| | - Tore Skaalhegg
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Andoni Elola
- BioRes Group, Department of Electronic Technology, University of the Basque Country (UPV/EHU), Eibar, Spain
| | | | | | - Elisabete Aramendi
- BioRes Group, Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | | | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Doctor Car 119, Air Ambulance Department, Division of Prehospital Care, Oslo University Hospital, Oslo, Norway.
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14
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Girotra S, Dukes KC, Sperling J, Kennedy K, Del Rios M, Crowe R, Panchal AR, Rea T, McNally BF, Chan PS. Emergency Medical Service Agency Practices and Cardiac Arrest Survival. JAMA Cardiol 2024; 9:683-691. [PMID: 38837166 PMCID: PMC11154368 DOI: 10.1001/jamacardio.2024.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/05/2024] [Indexed: 06/06/2024]
Abstract
Importance Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival. Objective To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies. Design, Setting, and Participants This cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023. Exposure Survey of resuscitation practices at EMS agencies. Main Outcomes and Measures Risk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival. Results Of 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (β = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (β = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (β = 0.48; P = .01), perform simulation training at least every 6 months (β = 0.63; P < .001), and conduct training in the use of mechanical CPR devices at least once annually (β = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (β = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P < .001). Conclusions and Relevance In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.
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Affiliation(s)
- Saket Girotra
- University of Texas Southwestern Medical Center, Dallas
| | | | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Kevin Kennedy
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus
| | - Thomas Rea
- King County Medic One Emergency Medical Services and Harborview Medical Center, University of Washington, Seattle
| | - Bryan F. McNally
- Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
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15
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Hopper K, Epstein SE, Burkitt-Creedon JM, Fletcher DJ, Boller M, Fausak ED, Mears K, Crews M. 2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR. J Vet Emerg Crit Care (San Antonio) 2024; 34 Suppl 1:16-43. [PMID: 38924625 DOI: 10.1111/vec.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.
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Affiliation(s)
- Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Jamie M Burkitt-Creedon
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erik D Fausak
- University Library, University of California, Davis, Davis, California, USA
| | - Kim Mears
- Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Molly Crews
- Department of Small animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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16
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Chandran K, Algaze Gonzalez IM, Wang S, Davis DP. Chest Decompressions - The Driver of CPR Efficacy: Exploring the Relationship Between Compression Rate, Depth, Recoil Velocity, and End-Tidal CO2. PREHOSP EMERG CARE 2024; 29:154-161. [PMID: 38830197 DOI: 10.1080/10903127.2024.2364058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Cardiopulmonary arrest survival is dependent on optimization of perfusion via high quality cardiopulmonary resuscitation (CPR), defined by a complex dynamic between rate, depth, and recoil velocity. Here we explore the interaction between these metrics and create a model that explores the impact of these variables on compression efficacy. METHODS This study was performed in a large urban/suburban fire-based emergency medical services (EMS) system over a nine-month period from 2019 to 2020. Manual chest compression parameters [rate/depth/recoil velocity] from a cohort of out-of-hospital cardiac arrest (OOHCA) victims were abstracted from monitor defibrillators (ZOLL X-series) and end-tidal carbon dioxide (ETCO2) from sensors. The mean values of these parameters were modeled against each other using multiple regression and structural equation modeling with ETCO2 as a dependent variable. RESULTS Data from a total of 335 patients were analyzed. Strong linear relationships were observed between compression depth/recoil velocity (r = .87, p < .001), ETCO2/depth (r = .23, p < .001) and ETCO2/recoil velocity (r = .61, p < .001). Parabolic relationships were observed between rate/depth (r = .39, p < .001), rate/recoil velocity (r = .26, p < .001), and ETCO2/rate (r = .20, p = .003). Rate, depth, and recoil velocity were modeled as independent variables and ETCO2 as a dependent variable with excellence model performance suggesting the primary driver of stroke volume to be recoil velocity rather than compression depth. CONCLUSIONS We used manual CPR metrics from out of hospital cardiac arrests to model the relationship between CPR metrics. These results consistently support the importance of chest recoil on CPR hemodynamics, suggesting that guidelines for optimal CPR should emphasize the importance of maximum chest recoil.
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Affiliation(s)
- Kira Chandran
- Georgetown University School of Medicine, Washington, District of Columbia
- Harvard Affiliated Emergency Medicine Residency Program, Mass General Brigham, Boston, Massachusetts
| | | | - Sixian Wang
- Georgetown University School of Medicine, Washington, District of Columbia
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17
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Tonna JE, Cho SM. Extracorporeal Cardiopulmonary Resuscitation. Crit Care Med 2024; 52:963-973. [PMID: 38224260 PMCID: PMC11098703 DOI: 10.1097/ccm.0000000000006185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Sung-Min Cho
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Division of Neuroscience Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Neuroscience Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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18
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Järvenpää V, Mäki P, Huhtala H, Elo H, Länkimäki S, Setälä P, Hoppu S. Compliance with CPR quality guidelines and survival after 30 days following out-of-hospital cardiac arrest. A retrospective study. Acta Anaesthesiol Scand 2024; 68:80-90. [PMID: 37726941 DOI: 10.1111/aas.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/27/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Our study assessed the quality of cardiopulmonary resuscitation (CPR) given by emergency medical services in Southern Ostrobothnia Finland, as is advised in the international guidelines. The goal was to evaluate the current quality of CPR given to patients who suffered an out-of-hospital cardiac arrest and to examine possible measures for improving emergency medical services. METHODS A retrospective study was conducted on out-of-hospital cardiac arrest patients in Southern Ostrobothnia, Finland, during a three-year period. Confounding caused by each patient's individual medical history was addressed by calculating Charlson Comorbidity Index (CCI), a score describing individual's risk for death in 10 years. The Utstein analysis and the CPR metrics were acquired from the medical records hospital district in question and analysed in an orderly manner using SPSS. Descriptive statistics are presented as mean (SD) and median [IQR]. RESULTS We found that of the 349 patients, 144 (41%) received ROSC, 96 (28%) survived to the hospital and 51 (15%) survived for at least 30 days. CPR metrics data were available for 181 patients. CCIs were 3.0 versus 5.0 (p = .157) for the ones who did and those who did not survive at least 30 days. Correspondingly, following metrics were as follows: Mean compression depth was 5.1 (1.3) versus 5.6 (0.8) cm (p = .088), median 28 [18;40] versus 40 [26;54]% of the compressions were in target depth (p = .015) and median compression rate was 113 [109;119] versus 112 [108;120] min-1 (p = .757). The median no-flow fraction was 5.1 [2.8;7.1] versus 3.7 [2.5;5.5] s (p = .073). Ventricular fibrillation (OR 8.74, 95% CI 2.89-26.43, p < .001), public location (OR 3.163, 95% CI 1.03-9.69, p = .044) and compression rate of 100-110/min (OR 7.923, 95% CI 2.11-29.82, p = .002) were related to survival. CONCLUSION Patients who suffered out-of-hospital cardiac arrest in Southern Ostrobothnia received CPR that met the international CPR quality target values. The proportion of unintentional pauses during CPR was low and the 30-day survival rate exceeded the international average.
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Affiliation(s)
- Valtteri Järvenpää
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Wellbeing Services County, Tampere, Finland
| | - Paula Mäki
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Wellbeing Services County, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Heini Elo
- Southern Ostrobothnia Wellbeing Services County, Seinäjoki, Finland
| | - Sami Länkimäki
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Wellbeing Services County, Tampere, Finland
| | - Piritta Setälä
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Wellbeing Services County, Tampere, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Wellbeing Services County, Tampere, Finland
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19
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Leo WZ, Chua D, Tan HC, Ho VK. Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study. Sci Rep 2023; 13:19852. [PMID: 37964016 PMCID: PMC10645752 DOI: 10.1038/s41598-023-46862-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.
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Affiliation(s)
- Wen Zhe Leo
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Damien Chua
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Hui Cheng Tan
- Department of Clinical Governance, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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20
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Sood N, Sangari A, Goyal A, Sun C, Horinek M, Hauger JA, Perry L. Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis. World J Cardiol 2023; 15:531-541. [PMID: 37900903 PMCID: PMC10600786 DOI: 10.4330/wjc.v15.i10.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA. METHODS We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05. RESULTS Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047]. CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.
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Affiliation(s)
- Nitish Sood
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
| | - Anish Sangari
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Arnav Goyal
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Christina Sun
- Dental College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Madison Horinek
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Joseph Andy Hauger
- Department of Chemistry and Physics, Augusta University, Augusta, GA 30912, United States
| | - Lane Perry
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
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21
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Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest. Resuscitation 2023; 185:109738. [PMID: 36806652 DOI: 10.1016/j.resuscitation.2023.109738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Quality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) often do not meet guideline recommendations for rate and depth. This may be due to the fatiguing nature of physically compressing a patient's chest, meaning that CPR quality reduces over time. OBJECTIVE This analysis investigates the effect of CPR duration on the performance of continuous CCs delivered by firefighters equipped with CPR feedback devices. METHODS Data were collected from a first responder group which used CPR feedback and automatic external defibrillator devices when attending out-of-hospital cardiac arrest events. Depth and rate of CC were analysed for 134 patients. Mean CC depth and rate were calculated every 5 s during two-minute episodes of CPR. Regression models were created to evaluate the relationship between applied CC depth and rate as a function of time. RESULTS Mean (SD) CC depth during the investigation was 48 (9) mm. An inverse relationship was observed between CC depth and CPR duration, where CC depth decreased by 3.39 mm, over two-minutes of CPR (p < 0.001). Mean (SD) CC rate was 112.06 (5.87) compressions per minute. No significant relationship was observed between CC rate and CPR duration (p = 0.077). Mean depth was within guideline range for 33.58% of patient events, while guideline rate was observed in 92.54% of cases. CONCLUSIONS A reduction in CC depth was observed during two-minutes of continuous CCs while CC rate was not affected. One third of patients received a mean CC depth within guideline range (50 to 60 mm).
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Ghaderi MS, Malekzadeh J, Mazloum S, Pourghaznein T. Comparison of real-time feedback and debriefing by video recording on basic life support skill in nursing students. BMC MEDICAL EDUCATION 2023; 23:62. [PMID: 36698121 PMCID: PMC9878936 DOI: 10.1186/s12909-022-03951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cardiopulmonary resuscitation skill have a direct impact on its success rate. Choosing the right method to acquire this skill can lead to effective performance. This investigation was conducted to compare the effect of Real-time feedback and debriefing by video recording on basic life support skill in nursing students. METHODS This quasi-experimental study was performed on 67 first year nursing students. First, a theoretical basic life support (BLS) training session was held for the all participants, at the end of session the pre-test was taken. Students were randomly assigned to two groups. A 4-hour practical BLS training session was conducted in the real - time feedback group as well as the debriefing by video recording group, and at the end of the training, a post-test was taken from each group. Each group received a post-test. Data were analyzed using SPSS 25 software. RESULTS Results showed a significant difference between mean (SD) of debriefing by video recording group in pre-test and post-test (p < 0.001) and in the real-time feedback group there was a significant difference between mean (SD) in pre-test and post-test (p < 0.001), respectively. In addition, there was no significant difference between the mean score of basic life support skill in real-time feedback and debriefing by video recording. CONCLUSIONS Both real-time feedback and debriefing by video recording were effective on basic life support skill.
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Affiliation(s)
- Mohammad Sajjad Ghaderi
- Department of Nursing, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Razavi Khorasan Province, Iran
- Clinical Research Development Unit, Sajjadieh Hospital, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Razavi Khorasan Province, Iran
| | - Javad Malekzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedreza Mazloum
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tayebe Pourghaznein
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Hubar I, Fischer M, Monaco T, Gräsner JT, Westenfeld R, Bernhard M. Development of the epidemiology and outcomes of out-of-hospital cardiac arrest using data from the German Resuscitation Register over a 15-year period (EpiCPR study). Resuscitation 2023; 182:109648. [PMID: 36423737 DOI: 10.1016/j.resuscitation.2022.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/22/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sudden cardiac arrest is a relevant problem with a significant number of deaths in Europe. AIM Using data from the German Resuscitation Register (GRR), we examined changes in epidemiology and therapeutic interventions over a 15-year period in order to identify key factors contributing to favourable outcome in out-of-hospital cardiac arrest (OHCA) patients. METHODS GRR data were analysed in 5-year periods (2006-2010 vs 2011-2015 vs 2016-2020) representing changes in the European Resuscitation Council (ERC) guidelines. Group comparison of OHCA patients was made for epidemiological and resuscitation-associated factors. Endpoints included 30-day survival and hospital discharge with a good neurological outcome (CPC 1,2). Matched-pair analysis compared outcomes, and multivariate binary logistic regression analysis identified variables with effects on survival. RESULTS A total of 42,997 GRR patients were studied (2006-2010: n = 3,471, 2011-2015: n = 16,122, 2016-2020: n = 23,404). Proportion of patients over 80 years, use of intraosseous (IO) access and supraglottic airway devices, rate of bystander CPR, and the proportion of telephone CPR increased over the study period. The 30-day survival, and hospital discharge rates with CPC1/2 were unchanged. After adjusting cohorts using matched pairs, a higher CPC1,2 rate was observed (8.8 vs 10.2%, p < 0.03). Logistic regression analysis showed that IO and SAD had an unfavourable impact on outcome. CONCLUSION Despite a significant increase in bystander and telephone CPR rates, no improvement in 30-day survival and hospital discharge rate with CPC1,2 was observed. Initial rhythm (VF/VT), cardiac and hypoxic cause of CA, bystander CPR and IV access were identified as factors associated with a favourable neurological outcome.
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Affiliation(s)
- Iryna Hubar
- Emergency Department, University Hospital of Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Matthias Fischer
- Department of Anesthesiology and Intensive Care, ALB FILS Kliniken, Eichertstraße 3, 73035 Göppingen, Germany
| | - Tobias Monaco
- Emergency Department, University Hospital of Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225 Duesseldorf, Germany
| | - Jan-Thorsten Gräsner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Medical Faculty, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital of Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225 Duesseldorf, Germany.
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Gugelmin-Almeida D, Tobase L, Maconochie I, Polastri T, Rodrigues Gesteira EC, Williams J. What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature. Resusc Plus 2022; 12:100319. [PMID: 36337082 PMCID: PMC9630773 DOI: 10.1016/j.resplu.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer's confidence. Methods This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer.
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Key Words
- APLS, Advanced paediatric life support
- ATLS, Advanced trauma life support
- BLS, Basic life support
- CPR, Cardiopulmonary resuscitation
- EM, Emergency medical
- EMS, Emergency medical services
- EPALS, European paediatric advanced life support
- Healthcare professionals
- ILCOR, International liaison committee on resuscitation
- PALS, Paediatric advanced life support
- PHPLS, Pre-hospital paediatric life support
- PILS, Paediatric intermediate life support
- Paediatric cardiopulmonary resuscitation
- RCT, Randomised controlled trial
- Retraining intervals
- Scoping review
- Training strategies
- pCPR, Paediatric cardiopulmonary resuscitation
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Ian Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Thatiane Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England
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Lv GW, Hu QC, Zhang M, Feng SY, Li Y, Zhang Y, Zhang YY, Wang WJ. Effect of real-time feedback on patient's outcomes and survival after cardiac arrest: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30438. [PMID: 36123918 PMCID: PMC9478281 DOI: 10.1097/md.0000000000030438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study investigated the effect of real-time feedback on the restoration of spontaneous circulation, survival to hospital discharge, and favorable functional outcomes after hospital discharge. METHODS PubMed, ScienceDirect, and China National Knowledge Infrastructure databases were searched to screen the relevant studies up to June 2020. Fixed-effects or random-effects model were used to calculate the pooled estimates of relative ratios (RRs) with 95% confidence intervals (CIs). RESULTS Ten relevant articles on 4281 cardiac arrest cases were identified. The pooled analyses indicated that real-time feedback did not improve restoration of spontaneous circulation (RR: 1.13, 95% CI: 0.92-1.37, and P = .24; I2 = 81%; P < .001), survival to hospital discharge (RR: 1.27, 95% CI: 0.90-1.79, and P = .18; I2 = 74%; P < .001), and favorable neurological outcomes after hospital discharge (RR: 1.09, 95% CI: 0.87-1.38; P = .45; I2 = 16%; P = .31). The predefined subgroup analysis showed that the sample size and arrest location may be the origin of heterogeneity. Begg's and Egger's tests showed no publication bias, and sensitivity analysis indicated that the results were stable. CONCLUSION The meta-analysis had shown that the implementation of real-time audiovisual feedback was not associated with improved restoration of spontaneous circulation, increased survival, and favorable functional outcomes after hospital discharge.
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Affiliation(s)
- Guang Wei Lv
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Qing Chang Hu
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Meng Zhang
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Shun Yi Feng
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Yong Li
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Yi Zhang
- Pediatric Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Yuan Yuan Zhang
- Nursing Department, Cangzhou Infectious Disease Hospital, Cangzhou City, China
| | - Wen Jie Wang
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
- *Correspondence: Wen Jie Wang, Emergency Department, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City 061000, China (e-mail: )
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. Mehr als 500 Kinder pro Jahr könnten gerettet werden! Zehn Thesen zur Verbesserung der Qualität pädiatrischer Reanimationen im deutschsprachigen Raum. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hirayama Y, Ito Y, Ogawa M, Fukushima Y, Ikeyama T. Quantitative assessment of chest compression techniques on an infant manikin. Pediatr Int 2022; 64:e15118. [PMID: 35616194 DOI: 10.1111/ped.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current cardiopulmonary resuscitation (CPR) guidelines recommend the two-finger technique (TFT) of chest compression (CC) in infants for a single rescuer. We hypothesized that healthcare providers cannot achieve adequate CC depth with TFT, even if using real-time visual feedback (RVF). METHODS This was a cross-over study, randomizing participants to perform three sets of 2-min continuous CC, comparing (i) TFT with RVF, (ii) the one-hand technique (OHT) without RVF, and (iii) OHT with RVF. A standard CPR trainer manikin of a 3-month-old infant and a monitor/defibrillator that displays and records the quantitative CC quality were used. We set a target compression depth of 40-50 mm and a target compression rate of 100-120/min. Data were analyzed using the Friedman test and Bonferroni correction. Statistical significance was defined as P-value of< 0.05. RESULTS Fifty-nine healthcare providers participated in the study. The mean compression depth was 24 mm (interquartile range [IQR], 22-26 mm) in TFT with RVF and 43 mm (IQR, 38-48 mm) in OHT without RVF, P < 0.001. The proportion of adequate CC depth was 0% (IQR, 0-0%) in TFT with RVF, 22% (IQR, 5-54%) in OHT without RVF, and 62% (IQR, 29-83%) in OHT with RVF. The mean compression rate was within the target range in all three techniques. CONCLUSIONS The TFT cannot produce the CC depth that meets the recommendation of the current CPR guidelines for an infant with RVF, whereas the OHT does.
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Affiliation(s)
- Yuji Hirayama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yurie Ito
- Division of Pediatric Emergency Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mariko Ogawa
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yasuhiro Fukushima
- Nursing Department, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Takanari Ikeyama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
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Musiari M, Saporito A, Ceruti S, Biggiogero M, Iattoni M, Glotta A, Cantini L, Capdevila X, Cassina T. Can a Glove-Coach Technology Significantly Increase the Efficacy of Cardiopulmonary Resuscitation on Non-healthcare Professionals? A Controlled Trial. Front Cardiovasc Med 2021; 8:685988. [PMID: 34957226 PMCID: PMC8695546 DOI: 10.3389/fcvm.2021.685988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiovascular accidents are the world's leading cause of death. A good quality cardiopulmonary resuscitation (CPR) can reduce cardiac arrest-associated mortality. This study aims to test the coaching system of a wearable glove, providing instructions during out-of-hospital CPR. Materials and Methods: We performed a single-blind, controlled trial to test non-healthcare professionals during a simulated CPR performed on an electronic mannequin. The no-glove group was the control. The primary outcome was to compare the accuracy of depth and frequency of two simulated CPR sessions. Secondary outcomes were to compare the decay of CPR performance and the percentage of the duration of accurate CPR. Results: About 130 volunteers were allocated to 1:1 ratio in both groups; mean age was 36 ± 15 years (min-max 21-64) and 62 (48%) were men; 600 chest compressions were performed, and 571 chest compressions were analyzed. The mean frequency in the glove group was 117.67 vs. 103.02 rpm in the control group (p < 0.001). The appropriate rate cycle was 92.4% in the glove group vs. 71% in the control group, with a difference of 21.4% (p < 0.001). Mean compression depth in the glove group was 52.11 vs. 55.17 mm in the control group (p < 0.001). A mean reduction of compression depth over time of 5.3 mm/min was observed in the control group vs. 0.83 mm/min of reduction in the glove group. Conclusion: Visual and acoustic feedbacks provided through the utilization of the glove's coaching system were useful for non-healthcare professionals' CPR performance.
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Affiliation(s)
- Michele Musiari
- Department of Anaesthesiology, Fribourg Cantonal Hospital (HFR), Villars-sur-Glâne, Switzerland.,University Clinic for Anesthesiology and Pain Therapy Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Saporito
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Martina Iattoni
- Department of Internal Medicine, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Andrea Glotta
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Laura Cantini
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Xavier Capdevila
- Montpellier University Hospital, Department of Anaesthesia and Intensive Care, Montpellier, France
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Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS). Prehosp Disaster Med 2021; 36:702-707. [PMID: 34645532 DOI: 10.1017/s1049023x21001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). METHODS This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. RESULTS There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. CONCLUSION Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.
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Meng XY, You J, Dai LL, Yin XD, Xu JA, Wang JF. Efficacy of a Simplified Feedback Trainer for High-Quality Chest Compression Training: A Randomized Controlled Simulation Study. Front Public Health 2021; 9:675487. [PMID: 34722430 PMCID: PMC8551574 DOI: 10.3389/fpubh.2021.675487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The most recent international guidelines recommended support training of chest compression (CC) using feedback devices. This study aimed to compare the training efficacy of a simplified feedback trainer with the traditional cardiopulmonary resuscitation (CPR) simulator in CPR training. Methods: A total of 60 soldiers were randomly allocated into three groups equally, trained with a simplified external cardiac massage (ECM) trainer named Soul SheathTM (SS) (SS group), a Resusci Anne manikin (RA group), or traditional simulation training with instructor feedback, respectively. After 7 days of training, the CPR skills were tested blindly in a 2-min assessment session. The primary outcome was the proportion of effective CC, and the secondary outcome included CC rate, depth, compression position, and extent of the release. Results: The percentage of effective CC achieved in the SS group was comparable with the RA group (77.0 ± 15.52 vs. 77.5 ± 10.73%, p = 0.922), and significantly higher than that in the control group (77.0 ± 15.52 vs. 66.8 ± 16.87%, p = 0.037). Both the SS and RA groups showed better CC performance than the control group in terms of CC rate (SS group vs. control group, P = 0.032 and RA group vs. control group, P = 0.026), the proportion of shallow CC (SS group vs. control group, P = 0.011 and RA group vs. control group, P = 0.017). No difference between the SS group and RA group was found in all the CC parameters. Conclusions: The simplified ECM trainer (SS) provides a similar efficacy to the traditional manikin simulator with feedback in CC training to improve the quality of CPR skills.
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Affiliation(s)
- Xiao-yan Meng
- Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Naval Medical University, Shanghai, China
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia You
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li-li Dai
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiao-dong Yin
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian-an Xu
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia-feng Wang
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
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Márquez-Hernández VV, Gutiérrez-Puertas L, Garrido-Molina JM, García-Viola A, Alcayde-García A, Aguilera-Manrique G. Worldviews on Evidence-Based Cardiopulmonary Resuscitation Using a Novel Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189536. [PMID: 34574460 PMCID: PMC8466558 DOI: 10.3390/ijerph18189536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
The evaluation of scientific content by researchers, as well as the knowledge networks and working groups of cardiopulmonary resuscitation, can help to improve and expand new scientific evidence in this field. The aim of this study was to identify the global scientific publications on cardiopulmonary resuscitation research using a novel method. The method used was based on obtaining bibliographic data automatically from scientific publications through the use of the Scopus Database API Interface. A total of 17,917 results were obtained, with a total of 60,226 reports and 53,634 authors. Six categories were detected with 38.56% corresponding to cardiac arrest, 21.8% to cardiopulmonary resuscitation, 17.16% to life-support training and education, 12.45% to ethics and decision-making in cardiac arrest, 4.77% to therapeutic treatment, and 3.72% to life-support techniques. Analyzing and identifying the main scientific contributions to this field of study can make it possible to establish collaboration networks and propose new lines of research, as well as to unify criteria for action. Future research should delve into the analyses of the other elements involved in this area.
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Affiliation(s)
- Verónica V. Márquez-Hernández
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Research Group for Health Sciences CTS-451, Health Research Center, 04120 Almería, Spain
| | - Lorena Gutiérrez-Puertas
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Experimental and Applied Neuropsychology Research Group HUM-061, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-950-21-45-85
| | - José M. Garrido-Molina
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
| | - Alba García-Viola
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
| | | | - Gabriel Aguilera-Manrique
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Research Group for Health Sciences CTS-451, Health Research Center, 04120 Almería, Spain
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Nichol G, Daya MR, Morrison LJ, Aufderheide TP, Vaillancourt C, Vilke GM, Idris A, Brown S. Compression depth measured by accelerometer vs. outcome in patients with out-of-hospital cardiac arrest. Resuscitation 2021; 167:95-104. [PMID: 34331984 DOI: 10.1016/j.resuscitation.2021.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Analyses of data recorded by monitor-defibrillators that measure CPR depth with different methods show significant relationships between the process and outcome of CPR. Our objective was to evaluate whether chest compression depth was significantly associated with outcome based on accelerometer-recordings obtained with monitor-defibrillators from a single manufacturer, and to assess whether an accelerometer-based analysis corroborated evidence-based practice guidelines on performance of CPR. METHODS AND RESULTS We included 5434 adult patients treated from seven US and Canadian cities between January 2007 and May 2015. These had mean (SD) age of 64.2 (17.2) years, mean compression depth of 45.9 (12.7) mm, ROSC sustained to ED arrival of 26%, and survival to hospital discharge of 8%. For survival to discharge, the adjusted odds ratios were 1.15 (95% CI, 0.86, 1.55) for cases within 2005 depth range (38-51 mm), and 1.17 (95% CI, 0.91, 1.50) for cases within 2010 depth range (>50 mm) compared to those with an average depth of <38 mm. The adjusted odds ratio of survival was 1.33 (95% CI, 1.01, 1.75) for cases within 2015 depth range (50 to 60 mm) for at least 60% of minutes. CONCLUSIONS This analysis of patients with OHCA demonstrated that increased chest compression depth measured by accelerometer is associated with better survival. It confirms that current evidence-based recommendations to compress within 50-60 mm are likely associated with greater survival than compressing to another depth.
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Affiliation(s)
- Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Departments of Medicine and Emergency Medicine, University of Washington, Seattle, WA, United States.
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Laurie J Morrison
- Department of Emergency Medicine, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Christian Vaillancourt
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego, CA, United States
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Siobhan Brown
- Department of Biostatistics, University of Washington, Seattle, WA, United States
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Sports safety matting diminishes cardiopulmonary resuscitation quality and increases rescuer perceived exertion. PLoS One 2021; 16:e0254800. [PMID: 34293018 PMCID: PMC8297772 DOI: 10.1371/journal.pone.0254800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Compliant surfaces beneath a casualty diminish the quality of cardiopulmonary resuscitation (CPR) in clinical environments. To examine this issue in a sporting environment, we assessed chest compression quality and rescuer exertion upon compliant sports safety matting. METHODS Twenty-seven advanced life support providers volunteered (13 male/14 female; mass = 79.0 ± 12.5 kg; stature = 1.77 ± 0.09 m). Participants performed 5 × 2 min, randomized bouts of continuous chest compressions on a mannequin, upon five surfaces: solid floor; low-compliance matting; low-compliance matting with a backboard; high-compliance matting; high-compliance matting with a backboard. Measures included chest compression depth and rate, percentage of adequate compressions, and rescuer heart rate and perceived exertion. RESULTS Chest compression depth and rate were significantly lower upon high-compliance matting relative to other surfaces (p<0.05). The percentage of adequate compressions (depth ≥50 mm) was lowest upon high-compliance matting (40 ± 39%) versus low-compliance matting (60 ± 36%) and low-compliance matting with a backboard (59 ± 39%). Perceived exertion was significantly greater upon high-compliance matting versus floor, low-compliance matting, and low-compliance matting with a backboard (p<0.05). CONCLUSION Providers of CPR should be alerted to the detrimental effects of compliant safety matting in a sporting environment and prepare to alter the targeted compression depth and rescuer rotation intervals accordingly.
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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Charlton K, McClelland G, Millican K, Haworth D, Aitken-Fell P, Norton M. The impact of introducing real time feedback on ventilation rate and tidal volume by ambulance clinicians in the North East in cardiac arrest simulations. Resusc Plus 2021; 6:100130. [PMID: 34223387 PMCID: PMC8244525 DOI: 10.1016/j.resplu.2021.100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/02/2022] Open
Abstract
Background Research suggests rescuers deliver ventilations outside of recommendations during out of hospital cardiac arrest (OHCA), which can be deleterious to survival. We aimed to determine if ambulance clinician compliance with ventilation recommendations could be improved using the Zoll Accuvent real time ventilation feedback device (VFD). Methods Participants simulated a two-minute cardiac arrest scenario using a mannequin and defibrillator without ventilation feedback. Eligible for inclusion were all clinicians aged ≥18 years who perform cardiopulmonary resuscitation (CPR) as part of their role, who had completed an internal advanced life support (ALS) refresher. Following familiarisation of a few minutes with the VFD, participants repeated the two-minute scenario with ventilation feedback. Ventilation rate and volume and CPR quality were recorded. Primary outcome was % difference in ventilation compliance with and without feedback. Secondary outcomes were differences between paramedic and non-paramedic clinicians and compliance with chest compression guidelines. Results One hundred and six participants completed the study. Median ventilation rate without feedback was 10 (IQR 8-14, range 4-30) compared to 9 (IQR 9-9, range 6-17) with feedback; median tidal volume without feedback was 630 mls (IQR 518-725, range 201-1114) compared to 546 mls (IQR 531-560, range 490-750) with feedback. Proportion of clinicians ≥50% compliant with European Resuscitation Council ventilation recommendations were significantly greater with ventilation feedback compared to without, 91% vs. 9%, (McNemars test p = <0.0001). Paramedics out performed non-paramedic clinicians with and without feedback and compression quality was not compromised by using the VFD. Conclusions Ambulance clinician baseline ventilation quality was frequently outside of recommendations, but a VFD can ensure treatment is within evidence-based recommendations. Further research is required to validate the use of the VFD in true clinical practice and to evaluate the relationship between improved ventilation quality during OHCA and patient outcomes.
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Affiliation(s)
- Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Karen Millican
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Daniel Haworth
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Paul Aitken-Fell
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Michael Norton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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Hajeb-M S, Cascella A, Valentine M, Chon KH. Deep Neural Network Approach for Continuous ECG-Based Automated External Defibrillator Shock Advisory System During Cardiopulmonary Resuscitation. J Am Heart Assoc 2021; 10:e019065. [PMID: 33663222 PMCID: PMC8174215 DOI: 10.1161/jaha.120.019065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Because chest compressions induce artifacts in the ECG, current automated external defibrillators instruct the user to stop cardiopulmonary resuscitation (CPR) while an automated rhythm analysis is performed. It has been shown that minimizing interruptions in CPR increases the chance of survival. Methods and Results The objective of this study was to apply a deep-learning algorithm using convolutional layers, residual networks, and bidirectional long short-term memory method to classify shockable versus nonshockable rhythms in the presence and absence of CPR artifact. Forty subjects' data from Physionet with 1131 shockable and 2741 nonshockable samples contaminated with 43 different CPR artifacts that were acquired from a commercial automated external defibrillator during asystole were used. We had separate data as train and test sets. Using our deep neural network model, the sensitivity and specificity of the shock versus no-shock decision for the entire data set over the 4-fold cross-validation sets were 95.21% and 86.03%, respectively. This result was based on the training and testing of the model using ECG data in both the presence and the absence of CPR artifact. For ECG without CPR artifact, the sensitivity was 99.04% and the specificity was 95.2%. A sensitivity of 94.21% and a specificity of 86.14% were obtained for ECG with CPR artifact. In addition to 4-fold cross-validation sets, we also examined leave-one-subject-out validation. The sensitivity and specificity for the case of leave-one-subject-out validation were 92.71% and 97.6%, respectively. Conclusions The proposed trained model can make shock versus nonshock decision in automated external defibrillators, regardless of CPR status. The results meet the American Heart Association's sensitivity requirement (>90%).
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Affiliation(s)
- Shirin Hajeb-M
- Biomedical Engineering Department University of Connecticut Storrs CT
| | | | | | - K H Chon
- Biomedical Engineering Department University of Connecticut Storrs CT
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KÜÇÜKCERAN K, AYRANCI M, ÖZER M. The Impact of Body Mass Index Values on the Quality of Cardiopulmonary Resuscitation: a Manikin Study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.775972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bylow H, Karlsson T, Lepp M, Claesson A, Lindqvist J, Svensson L, Herlitz J. Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces: a Cluster Randomised, Controlled Trial. MEDICAL SCIENCE EDUCATOR 2021; 31:161-173. [PMID: 34457876 PMCID: PMC8368380 DOI: 10.1007/s40670-020-01160-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The goal for laypersons after training in basic life support (BLS) is to act effectively in an out-of-hospital cardiac arrest situation. However, it is still unclear whether BLS training targeting laypersons at workplaces is optimal or whether other effective learning activities are possible. AIM The primary aim was to evaluate whether there were other modes of BLS training that improved learning outcome as compared with a control group, i.e. standard BLS training, six months after training, and secondarily directly after training. METHODS In this multi-arm trial, lay participants (n = 2623) from workplaces were cluster randomised into 16 different BLS interventions, of which one, instructor-led and film-based BLS training, was classified as control and standard, with which the other 15 were compared. The learning outcome was the total score for practical skills in BLS calculated using the modified Cardiff Test. RESULTS Four different training modes showed a significantly higher total score compared with standard (mean difference 2.3-2.9). The highest score was for the BLS intervention including a preparatory web-based education, instructor-led training, film-based instructions, reflective questions and a chest compression feedback device (95% CI for difference 0.9-5.0), 6 months after training. CONCLUSION BLS training adding several different combinations of a preparatory web-based education, reflective questions and chest compression feedback to instructor-led training and film-based instructions obtained higher modified Cardiff Test total scores 6 months after training compared with standard BLS training alone. The differences were small in magnitude and the clinical relevance of our findings needs to be further explored. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03618888. Registered August 07, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03618888. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01160-3.
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Affiliation(s)
- Helene Bylow
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Østfold University College, Halden, Norway
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | | | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers Västra Götaland, Gothenburg, Sweden
- Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Kaplow R, Cosper P, Snider R, Boudreau M, Kim JD, Riescher E, Higgins M. Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest. AACN Adv Crit Care 2020; 31:401-409. [PMID: 33313710 DOI: 10.4037/aacnacc2020297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. OBJECTIVES To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. METHODS An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. RESULTS Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. CONCLUSIONS These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.
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Affiliation(s)
- Roberta Kaplow
- Roberta Kaplow is Critical Care Clinical Nurse Specialist, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322
| | - Pam Cosper
- Pam Cosper is Executive Director for Professional Practice, Center for Nursing Excellence and Wellstar Development Center, Wellstar Health System, Atlanta, Georgia
| | - Ray Snider
- Ray Snider is Unit Director of the Medical ICU and Co-chair of the Resuscitation Committee, Emory University Hospital, Atlanta, Georgia
| | - Martha Boudreau
- Martha Boudreau is Unit Nurse Educator, Coronary Care Unit, Emory University Hospital, Atlanta, Georgia
| | - John D Kim
- John D. Kim is Hospitalist, Emory St Joseph Hospital, and Assistant Professor, Emory School of Medicine, Atlanta, Georgia
| | - Elizabeth Riescher
- Elizabeth Riescher is Nurse Scholar, Cardiovascular ICU, Emory University Hospital, Atlanta, Georgia
| | - Melinda Higgins
- Melinda Higgins is Biostatistician and Research Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Karasek J, Ostadal P, Klein F, Rechova A, Seiner J, Strycek M, Polasek R, Widimsky P. LUCAS II Device for Cardiopulmonary Resuscitation in a Nonselective Out-of-Hospital Cardiac Arrest Population Leads to Worse 30-Day Survival Rate Than Manual Chest Compressions. J Emerg Med 2020; 59:673-679. [DOI: 10.1016/j.jemermed.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
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Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A35-A79. [PMID: 33098921 PMCID: PMC7576327 DOI: 10.1016/j.resuscitation.2020.09.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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43
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Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KK, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Svavarsdóttir H, Raffay V, Kuzovlev A, Grasner JT, Dee R, Smith M, Rajendran K. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S41-S91. [DOI: 10.1161/cir.0000000000000892] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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Dyson K, Brown SP, May S, Sayre M, Colella M, Daya MR, Roth R, Nichol G. Community lessons to understand resuscitation excellence (culture): Association between emergency medical services (EMS) culture and outcome after out-of-hospital cardiac arrest. Resuscitation 2020; 156:202-209. [PMID: 32979404 DOI: 10.1016/j.resuscitation.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The large geographic variation in outcome after out-of-hospital cardiac arrest (OHCA) is not well explained by traditional patient and emergency medical services (EMS) characteristics. A 'culture of excellence' in resuscitation within an EMS is believed to be an important factor that influences quality of care and outcome in patients with OHCA. However, whether a culture of excellence is associated with improved survival after OHCA is not known. METHODOLOGY We linked survey responses from EMS agency medical directors related to resuscitation culture to a retrospective analysis of prospectively collected data from the Resuscitation Outcomes Consortium (ROC) Epistry - Cardiac Arrest. We used a multivariable random effects model to assess whether EMS culture strategies were associated with OHCA survival to hospital discharge. RESULTS Of the 46 EMS medical directors surveyed, 35 (76%) provided a complete response. Included were n = 66,597 cases of OHCA who received attempted resuscitation by one of n = 123 EMS agencies from July 1, 2010, through June 30, 2015. Overall survival to discharge was 11%. Organizational values and goals were independently associated with survival to hospital discharge in all OHCAs (adjusted odds ratio [AOR] 1.27, 95% confidence interval [CI] 1.09-1.48) and the subgroup restricted to bystander witnessed OHCAs with initial shockable rhythm (AOR 1.55, 95% CI 1.21-1.99). CONCLUSIONS An organizational goal to improve OHCA survival was independently associated with improved survival to discharge. EMS agencies looking to improve OHCA survival should consider implementing an organizational goal to improve OHCA survival and empower quality improvement personnel to drive that goal.
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Affiliation(s)
- Kylie Dyson
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia.
| | - Siobhan P Brown
- University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Susanne May
- University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Michael Sayre
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Mario Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Ronald Roth
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA, United States
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland). Front Pediatr 2020; 8:549710. [PMID: 33117762 PMCID: PMC7575775 DOI: 10.3389/fped.2020.549710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.
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Affiliation(s)
- Philipp Jung
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sebastian Brenner
- Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Iris Bachmann
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Christian Both
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Eich
- Department of Anaesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | | | - Ralf Huth
- University Children's Hospital, Mainz, Germany
| | - Ellen Heimberg
- Department of Pediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | | | - Martin Olivieri
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Sasse
- University Children's Hospital, Medical School Hannover, Hanover, Germany
| | - Thomas Weisner
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gert Warnke
- University Children's Hospital Graz, Graz, Austria
| | | | - Bernd W. Boettiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, United States
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Wang SA, Su CP, Fan HY, Hou WH, Chen YC. Effects of real-time feedback on cardiopulmonary resuscitation quality on outcomes in adult patients with cardiac arrest: A systematic review and meta-analysis. Resuscitation 2020; 155:82-90. [PMID: 32755666 DOI: 10.1016/j.resuscitation.2020.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023]
Abstract
AIM To investigate the relationship between the implementation of real-time audiovisual cardiopulmonary resuscitation (CPR) feedback devices with cardiac arrest patient outcomes, such as return of spontaneous circulation (ROSC), short-term survival, and neurological outcome. METHODS We systematically searched PubMed, Embase, and the Cochrane CENTRAL from inception date until April 30, 2020, for eligible randomized and nonrandomized studies. Pooled odds ratio (OR) for each binary outcome was calculated using R system. The primary patient outcome was ROSC. The secondary outcomes were short-term survival and favorable neurological outcomes (cerebral performance category scores: 1 or 2). RESULTS We identified 11 studies (8 nonrandomized and 3 randomized studies) including 4851 patients. Seven studies documented patients with out-of-hospital cardiac arrest and four studies documented patients with in-hospital cardiac arrest. The pooled results did not confirm the effectiveness of CPR feedback device, possibly because of the high heterogeneity in ROSC (OR: 1.42, 95% CI: 1.03-1.94, I2: 80%, tau2: 0.1875, heterogeneity test p < 0.01) and survival-to-discharge (OR: 1.27, 95% CI: 0.74-2.18, I2: 86%, tau2: 0.4048, heterogeneity test p < 0.01). The subgroup analysis results revealed that heterogeneity was due to the types of devices used. Patient outcomes were more favorable in studies investigating portable devices than in studies investigating automated external defibrillator (AED)-associated devices. CONCLUSIONS Whether real-time CPR feedback devices can improve patient outcomes (ROSC and short-term survival) depend on the type of device used. Portable devices led to better outcomes than did AED-associated devices. Future studies comparing different types of devices are required to reach robust conclusion. PROTOCOL REGISTRATION Prospero registration ID CRD42020155388.
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Affiliation(s)
- Shao-An Wang
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chan-Ping Su
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsien-Yu Fan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center of Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Almeida D, Clark C, Jones M, McConnell P, Williams J. Consistency and variability in human performance during simulate infant CPR: a reliability study. Scand J Trauma Resusc Emerg Med 2020; 28:91. [PMID: 32912284 PMCID: PMC7488154 DOI: 10.1186/s13049-020-00785-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/01/2020] [Indexed: 01/26/2023] Open
Abstract
Background Positive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR. Methods An experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines. Results A high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices. Conclusion iCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.
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Affiliation(s)
- Debora Almeida
- Faculty of Health and Social Sciences, Bournemouth University, R604, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England. .,Department of Anesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England.
| | - Carol Clark
- Faculty of Health and Social Sciences, Bournemouth University, R612, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England
| | - Michael Jones
- Cardiff School of Engineering, Cardiff University, Cardiff, CF23 3AA, Wales
| | - Phillip McConnell
- Resuscitation Services, Heart Club, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, England
| | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, R611, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England
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Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of Physical Activity of the Rescuer on Chest Compression Duration and its Effects on Hemodynamics and Fatigue Levels of the Rescuer: A Simulation-based Study. Indian J Crit Care Med 2020; 24:409-413. [PMID: 32863632 PMCID: PMC7435083 DOI: 10.5005/jp-journals-10071-23457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) is a lifesaving skill performed during the cardiac arrest. Various factors of rescuer affect CPR quality, and rescuers physical fitness is one among the important factors needs to be explored for improved CPR quality. This study aimed to assess the physical activity (PA) levels of the health care providers (HCPs) who were trained in basic life support (BLS) and its relationship on chest compression duration, hemodynamic parameters, and fatigue levels of the rescuers. Materials and methods A single-center, cross-sectional study was conducted on 48 HCPs who were trained in BLS within one year. Eligible participants were contacted by email, and the responders’ level of PA was determined using the global physical activity questionnaire (GPAQ). The participants were recruited for chest compression-only cardiac arrest scenarios. Each subject performed continuous chest compression on the manikin until they perceived maximum fatigue. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), and fatigue level were assessed at baseline, immediately after and following two minutes of cessation of chest compressions. The total duration of chest compression was also documented. Results Most participants (24, 50%) reported high levels of PA while 22 (45.83%) and 2 (4.17%) reported moderate and low intensity of PA, respectively. The mean age of the 35 participants was 26.08 ± 4.60 years. The mean duration of chest compressions was 193.25 seconds with higher times reported for those with high PA when compared to those with moderate PA (p = 0.017). Similar findings were also observed for fatigue. Conclusion Rescuers who reported high PA had lower levels of fatigue and could perform longer duration of chest compressions. How to cite this article Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of Physical Activity of the Rescuer on Chest Compression Duration and its Effects on Hemodynamics and Fatigue Levels of the Rescuer: a Simulation-based Study. Indian J Crit Care Med 2020;24(6):409–413.
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Affiliation(s)
- Varun R Nayak
- Department of Respiratory Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Akhila Babu
- Department of Respiratory Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ramesh Unnikrishnan
- Department of Respiratory Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Pulse rate as an alternative, real-time feedback indicator for chest compression rate: a porcine model of cardiac arrest. J Clin Monit Comput 2020; 35:1159-1167. [PMID: 32780354 PMCID: PMC7418281 DOI: 10.1007/s10877-020-00576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation (CPR). However, the application of feedback indicators in the clinic practice is rare. Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR. However, it is unclear if pulse oximetry can monitor the quality of chest compression. We hypothesized that pulse rate monitored by pulse oximetry can be used as a feedback indicator of the chest compression rate during CPR in a porcine model of cardiac arrest. Seven domestic male pigs (30–35 kg) were utilized in this study. Eighteen intermittent chest compression periods of 2 min were performed on each animal. Chest compression and pulse oximetry plethysmographic waveforms were recorded simultaneously. Chest compression and pulse rates were calculated based on both waveforms. Compression interruption and synchronous pulse interruption times were also measured. Agreement was analyzed between pulse rates and synchronous chest compression rates, as well as between compression interruption times and synchronous pulse interruption times. A total of 126 compression periods of 2 min were performed on seven animals. Interclass correlation coefficients and Bland–Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates. Similarly, compression interruption and synchronous pulse interruption times obtained also showed high agreement. Pulse rate can be used as an alternative indicator of chest compression rate during CPR in a porcine model of cardiac arrest. Pulse interruption time also can be used to reflect compression interruption time precisely in this model.
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50
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Kong SYJ, Song KJ, Shin SD, Ro YS, Myklebust H, Birkenes TS, Kim TH, Park KJ. Effect of real-time feedback during cardiopulmonary resuscitation training on quality of performances: A prospective cluster-randomized trial. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907918825016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The evidence supporting delivery of quality cardiopulmonary resuscitation is growing and significant attention has been focused on improving bystander cardiopulmonary resuscitation education for laypeople. The aim of this randomized trial was to assess the effectiveness of instructor’s real-time objective feedback during cardiopulmonary resuscitation training compared to conventional feedback in terms of trainee’s cardiopulmonary resuscitation quality. Methods: We performed a cluster-randomized trial of community cardiopulmonary resuscitation training classes at Nowon District Health Community Center in Seoul. Cardiopulmonary resuscitation training classes were randomized into either intervention (instructor’s objective real-time feedback based on the QCPR Classroom device) or control (conventional, instructor’s judgment-based feedback) group. The primary outcome was total cardiopulmonary resuscitation score, which is an overall measure of chest compression quality. Secondary outcomes were individual cardiopulmonary resuscitation performance parameters, including compression rate, depth, and release. Generalized linear mixed models were used to analyze the outcome data, accounting for both random and fixed effects. Results: A total of 149 training sessions (2613 trainees) were randomized into 70 intervention (1262 trainees) and 79 control (1351 trainees) groups. Trainees in the QCPR feedback group significantly increased overall cardiopulmonary resuscitation score performance compared with those in the conventional feedback group (model-based mean Δ increment from baseline to session 5: 11.2 (95% confidence interval 9.2–13.2) and 8.0 (6.0–9.9), respectively; p = 0.02). Individual parameters of compression depth and release also showed higher improvement among trainees in QCPR group with positive trends (p < 0.08 for both). Conclusion: This randomized trial suggests beneficial effect of instructor’s real-time objective feedback on the quality of layperson’s cardiopulmonary resuscitation performance.
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Affiliation(s)
- So Yeon Joyce Kong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | | | | | - Tae Han Kim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Kwan Jin Park
- Department of Emergency Medicine, Chungbuk National University College of Medicine and Hospital, Cheongju-si, Republic of Korea
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