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Nord A, Hult H, Kreitz-Sandberg S, Herlitz J, Svensson L, Nilsson L. Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students' practical skills and willingness to act: a cluster randomised trial. BMJ Open 2017; 7:e014230. [PMID: 28645953 PMCID: PMC5623365 DOI: 10.1136/bmjopen-2016-014230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students' practical skills and willingness to act. SETTINGS Seventh grade students in council schools of two municipalities in south-east Sweden. DESIGN School classes were randomised to CPR training only (O), CPR training with a practical test including feedback (T) or CPR training with reflection and a practical test including feedback (RT). Measures of practical skills and willingness to act in a potential life-threatening situation were studied directly after training and at 6 months using a digital reporting system and a survey. A modified Cardiff test was used to register the practical skills, where scores in each of 12 items resulted in a total score of 12-48 points. The study was conducted in accordance with current European Resuscitation Council guidelines during December 2013 to October 2014. PARTICIPANTS 29 classes for a total of 587 seventh grade students were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The total score of the modified Cardiff test at 6 months was the primary outcome. Secondary outcomes were the total score directly after training, the 12 individual items of the modified Cardiff test and willingness to act. RESULTS At 6 months, the T and O groups scored 32 (3.9) and 30 (4.0) points, respectively (p<0.001), while the RT group scored 32 (4.2) points (not significant when compared with T). There were no significant differences in willingness to act between the groups after 6 months. CONCLUSIONS A practical test including feedback directly after training improved the students' acquisition of practical CPR skills. Reflection did not increase further CPR skills. At 6-month follow-up, no intervention effect was found regarding willingness to make a life-saving effort.
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Affiliation(s)
- Anette Nord
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Hult
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | | | - Johan Herlitz
- The Prehospital Research Centre of Western Sweden, Borås University, Borås, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Suen KF, Leung R, Leung LP. Therapeutic Hypothermia for Asphyxial Out-of-Hospital Cardiac Arrest Due to Drowning: A Systematic Review of Case Series and Case Reports. Ther Hypothermia Temp Manag 2017; 7:210-221. [PMID: 28570829 DOI: 10.1089/ther.2017.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The objective of this review was to summarize published evidence of the effectiveness of therapeutic hypothermia in patients with drowning-associated asphyxial out-of-hospital cardiac arrest (OHCA) and to explore any preliminary favorable factors in the management of therapeutic hypothermia to improve survival and neurological outcome. Drowning may result in asphyxial OHCA or hypothermic OHCA, but the former does not provide any potential neuroprotective effect as the latter may do. Electronic literature searches of Ovid Medline, Embase, Cochrane Library, and Scopus were performed for all years from inception to July 2016. Primary studies in the form of case reports, letters to the editor, and others with higher quality are included, but guidelines, reviews, editorials, textbook chapters, conference abstracts, and nonhuman studies are excluded. Non-English articles are excluded. Relevant studies are then deemed eligible if the drowning OHCA patient's initial temperature was above 28°C, which implies asphyxial cardiac arrest, and intentional therapeutic hypothermia was instituted. Because of the narrow scope of interest and strict definition of the condition, limited studies addressed it, and no randomized controlled trials (RCT) could be selected. Thirteen studies covering 35 patients are included. No quantitative synthesis, assessment of study quality, or assessment of bias was performed. It is conjectured that extended therapeutic hypothermia of 48-72 hours might help prevent reperfusion injury during the intermediate phase of postcardiac arrest care to benefit patients of drowning-associated asphyxial OHCA, but this finding only serves as preliminary observation for future research. No conclusive recommendation could be made regarding the duration of and the time of onset of therapeutic hypothermia. Future research should put effort on RCT, particularly the effect of extended duration of 48-72 hours. Important parameters should be reported in detail. Asphyxial and hypothermic OHCA should be differentiated.
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Affiliation(s)
- K-F Suen
- 1 School of Medicine, University College Dublin , Dublin, Ireland
| | - Reynold Leung
- 2 Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong, Hong Kong
| | - Ling-Pong Leung
- 2 Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong, Hong Kong
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Schröder H, Henke A, Stieger L, Beckers S, Biermann H, Rossaint R, Sopka S. Influence of learning styles on the practical performance after the four-step basic life support training approach - An observational cohort study. PLoS One 2017; 12:e0178210. [PMID: 28542636 PMCID: PMC5439953 DOI: 10.1371/journal.pone.0178210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/09/2017] [Indexed: 11/17/2022] Open
Abstract
Background Learning and training basic life support (BLS)—especially external chest compressions (ECC) within the BLS-algorithm—are essential resuscitation training for laypersons as well as for health care professionals. The objective of this study was to evaluate the influence of learning styles on the performance of BLS and to identify whether all types of learners are sufficiently addressed by Peyton’s four-step approach for BLS training. Methods A study group of first-year medical students (n = 334) without previous medical knowledge was categorized according to learning styles using the German Lernstilinventar questionnaire based on Kolb’s Learning Styles Inventory. Students’ BLS performances were assessed before and after a four-step BLS training approach lasting 4 hours. Standardized BLS training was provided by an educational staff consisting of European Resuscitation Council-certified advanced life support providers and instructors. Pre- and post-intervention BLS performance was evaluated using a single-rescuer-scenario and standardized questionnaires (6-point-Likert-scales: 1 = completely agree, 6 = completely disagree). The recorded points of measurement were the time to start, depth, and frequency of ECC. Results The study population was categorized according to learning styles: diverging (5%, n = 16), assimilating (36%, n = 121), converging (41%, n = 138), and accommodating (18%, n = 59). Independent of learning styles, both male and female participants showed significant improvement in cardiopulmonary resuscitation (CPR) performance. Based on the Kolb learning styles, no significant differences between the four groups were observed in compression depth, frequency, time to start CPR, or the checklist-based assessment within the baseline assessment. A significant sex effect on the difference between pre- and post-interventional assessment points was observed for mean compression depth and mean compression frequency. Conclusions The findings of this work show that the four-step-approach for BLS training addresses all types of learners independent of their learning styles and does not lead to significant differences in the performance of CPR.
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Affiliation(s)
- Hanna Schröder
- Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany.,Aachen Interdisciplinary Training Centre for Medical Education, Medical Faculty RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
| | - Alexandra Henke
- Department of Internal Medicine, Hermann-Josef-Hospital, Erkelenz, North Rhine-Westphalia, Germany
| | - Lina Stieger
- Aachen Interdisciplinary Training Centre for Medical Education, Medical Faculty RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
| | - Stefan Beckers
- Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany.,Aachen Interdisciplinary Training Centre for Medical Education, Medical Faculty RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
| | - Henning Biermann
- Department of Internal Medicine, Agaplesion Elisabethenstift, Darmstadt, Hesse, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
| | - Saša Sopka
- Department of Anaesthesiology, University Hospital RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany.,Aachen Interdisciplinary Training Centre for Medical Education, Medical Faculty RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
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Hyldmo PK, Horodyski M, Conrad BP, Aslaksen S, Røislien J, Prasarn M, Rechtine GR, Søreide E. Does the novel lateral trauma position cause more motion in an unstable cervical spine injury than the logroll maneuver? Am J Emerg Med 2017; 35:1630-1635. [PMID: 28511807 DOI: 10.1016/j.ajem.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position. The lateral trauma position is a novel technique that aims to combine airway management with spinal precautions. The objective of this study was to compare the spinal motion allowed by the novel lateral trauma position and the well-established log-roll maneuver. METHODS Using a full-body cadaver model with an induced globally unstable cervical spine (C5-C6) lesion, we investigated the mean range of motion (ROM) produced at the site of the injury in six dimensions by performing the two maneuvers using an electromagnetic tracking device. RESULTS Compared to the log-roll maneuver, the lateral trauma position caused similar mean ROM in five of the six dimensions. Only medial/lateral linear motion was significantly greater in the lateral trauma position (1.4mm (95% confidence interval [CI] 0.4, 2.4mm)). CONCLUSIONS In this cadaver study, the novel lateral trauma position and the well-established log-roll maneuver resulted in comparable amounts of motion in an unstable cervical spine injury model. We suggest that the lateral trauma position may be considered for unconscious non-intubated trauma patients.
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Affiliation(s)
- Per Kristian Hyldmo
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway; Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.
| | - MaryBeth Horodyski
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA.
| | - Bryan P Conrad
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA; Nike Inc., Portland, Oregon, USA
| | - Sindre Aslaksen
- Division of EMS, Sørlandet Hospital, Kristiansand, Norway; Norwegian Air Ambulance, Drøbak, Norway.
| | - Jo Røislien
- Department of Health Studies, University of Stavanger, Stavanger, Norway.
| | - Mark Prasarn
- Department of Orthopedics, University of Texas, Huston, Texas, USA.
| | - Glenn R Rechtine
- Bay Pines VAHCS, Bay Pines, Florida, USA; University of South Florida, Tampa, Florida, USA
| | - Eldar Søreide
- Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
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105
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González BS, Martínez L, Cerdà M, Piacentini E, Trenado J, Quintana S. Assessing practical skills in cardiopulmonary resuscitation: Discrepancy between standard visual evaluation and a mechanical feedback device. Medicine (Baltimore) 2017; 96:e6515. [PMID: 28353609 PMCID: PMC5380293 DOI: 10.1097/md.0000000000006515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This paper aims to analyze agreement in the assessment of external chest compressions (ECC) by 3 human raters and dedicated feedback software.While 54 volunteer health workers (medical transport technicians), trained and experienced in cardiopulmonary resuscitation (CPR), performed a complete sequence of basic CPR maneuvers on a manikin incorporating feedback software (Laerdal PC v 4.2.1 Skill Reporting Software) (L), 3 expert CPR instructors (A, B, and C) visually assessed ECC, evaluating hand placement, compression depth, chest decompression, and rate. We analyzed the concordance among the raters (A, B, and C) and between the raters and L with Cohen's kappa coefficient (K), intraclass correlation coefficients (ICC), Bland-Altman plots, and survival-agreement plots.The agreement (expressed as Cohen's K and ICC) was ≥0.54 in only 3 instances and was ≤0.45 in more than half. Bland-Altman plots showed significant dispersion of the data. The survival-agreement plot showed a high degree of discordance between pairs of raters (A-L, B-L, and C-L) when the level of tolerance was set low.In visual assessment of ECC, there is a significant lack of agreement among accredited raters and significant dispersion and inconsistency in data, bringing into question the reliability and validity of this method of measurement.
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Affiliation(s)
- Baltasar Sánchez González
- Intensive Care Department, Hospital Universitari Mútua Terrassa. PhD program, University of Barcelona. Terrassa, Spain
- Consell Català de Ressuscitació. Barcelona, Spain
| | - Laura Martínez
- Intensive Care Department, Hospital Universitari Mútua Terrassa. University of Barcelona. Terrassa, Spain
| | - Manel Cerdà
- Consell Català de Ressuscitació. Barcelona, Spain
| | - Enrique Piacentini
- Intensive Care Department, Hospital Universitari Mútua Terrassa. University of Barcelona. Terrassa, Spain
| | - Josep Trenado
- Intensive Care Department, Hospital Universitari Mútua Terrassa. University of Barcelona. Terrassa, Spain
| | - Salvador Quintana
- Consell Català de Ressuscitació. Barcelona, Spain
- Intensive Care Department, Hospital Universitari Mútua Terrassa. University of Barcelona. Terrassa, Spain
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Beom JH, You JS, Kim MJ, Seung MK, Park YS, Chung HS, Chung SP, Park I. Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study. Scand J Trauma Resusc Emerg Med 2017; 25:8. [PMID: 28122604 PMCID: PMC5267458 DOI: 10.1186/s13049-017-0352-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/18/2017] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to identify the relationship between the deeper and faster chest compressions suggested by the 2010 cardiopulmonary resuscitation guidelines and complications arising from chest compressions, using multi-detector computed tomography. Methods We performed a retrospective analysis of prospective registry data. This study was conducted with in- and out-of-hospital cardiac arrest patients who underwent successful resuscitation in the emergency departments of two academic tertiary care centres from October 2006 to September 2010 (pre-2010 group) and from October 2011 to September 2015 (post-2010 group). We examined chest injuries related to chest compressions, classified as follows: rib fracture, sternal fracture, and other uncommon complications. Results We enrolled 185 patients in this study. The most frequent complication to occur in both groups was rib fracture: 27 (62.8%) and 112 (78.9%) patients in the pre-2010 and post-2010 groups, respectively (p = 0.03). However, we observed no statistical differences in sternum fracture, the second most common complication (p = 0.80). Retrosternal and mediastinal haematoma were not reported in the pre-2010 group but 13 patients (9.1%) in the post-2010 group were reported to have haematoma (p = 0.04). Nine serious, life-threatening complications occurred, all in the post-2010 group. Among the younger group (less than 65 years old), 8 (38.1%) patients in the pre-2010 group and 40 (64.5%) in the post-2010 group sustained rib fractures. Discussion The deeper and faster chest compressions for enhancing ROSC are associated with increased occurrence of complications. Additional studies are needed to compensate for the limitations of our study design. Conclusions This study found that the 2010 guidelines, recommending deeper and faster chest compressions, led to an increased proportion of rib fractures and retrosternal and mediastinal haematoma.
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Affiliation(s)
- Jin Ho Beom
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Min Kyung Seung
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Gyeonggi-Do, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
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Barcala-Furelos R, Abelairas-Gómez C, Domínguez-Vila P, Vales-Porto C, López-García S, Palacios-Aguilar J. Policía costera de Vigo. Estudio piloto cuasi-experimental sobre rescate y RCP / Coastal Police of Vigo. A Quasi-Experimental Pilot Study about Rescue and CPR. REVISTA INTERNACIONAL DE MEDICINA Y CIENCIAS DE LA ACTIVIDAD FÍSICA Y DEL DEPORTE 2017. [DOI: 10.15366/rimcafd2017.66.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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108
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Keilholz G, Mutzbauer TS. The laryngeal tube - a helpful tool for cardiopulmonary resuscitation in the dental office? Br Dent J 2016; 218:E15. [PMID: 25952455 DOI: 10.1038/sj.bdj.2015.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Supraglottic airway adjuncts such as the laryngeal tube (LT) have been recommended to be used by cardiopulmonary resuscitation (CPR) first responders.Objective This study aims to evaluate the performance characteristics of dental students and dentists using the LT in comparison to a conventional bag valve mask device (BVM) within manikin CPR training. METHOD A group of eight dentists and 12 dental students performed randomised crossover CPR training using LT and BVM. Time intervals needed to perform five CPR cycles were recorded, as well as tidal and total gastric inflation volumes. RESULTS Median tidal volumes 0-1025 ml (median 462.5 ml) were observed using BVM and 100-500 ml (median 237.5 ml) with LT (p = 0.02). Total gastric inflation of 0-2900 ml was measured using BVM, no gastric inflation using LT (p = 0.0005). Time intervals needed to perform five CPR cycles did not differ between BVM (range 87.5-354.5 s, median 112 s) and LT (range 84.7-322.3 s, median 114 s) (p = 0.55). A median delay of 37.6 s (range 0-82.1 s) before starting CPR was observed using LT. CONCLUSIONS Lower tidal volumes but also lower or even no gastric inflation may be observed when dentists use a laryngeal tube during CPR. Respective training must focus on chest compressions. These must be started before inserting the LT or a different supraglottic airway adjunct and be delivered continuously during insertion. It is recommended to use a supraglottic airway such as an LT only after having been trained in its use.
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Affiliation(s)
- G Keilholz
- Mutzbauer &Partner, Maxillofacial Surgery and Dental Anaesthesiology, Tiefenhoefe 11, CH-8001 Zürich, Switzerland
| | - T S Mutzbauer
- 1] Mutzbauer &Partner, Maxillofacial Surgery and Dental Anaesthesiology, Tiefenhoefe 11, CH-8001 Zürich, Switzerland [2] Institute for Anatomy and Cell Biology, University of Heidelberg, Im Neuenheimer Feld 307, D-69120, Heidelberg, Germany
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109
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Huang Q, Hu C, Mao J. Are Chinese Students Willing to Learn and Perform Bystander Cardiopulmonary Resuscitation? J Emerg Med 2016; 51:712-720. [DOI: 10.1016/j.jemermed.2016.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/27/2015] [Accepted: 02/17/2016] [Indexed: 10/20/2022]
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110
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Atemwegsanatomie. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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111
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Bleijenberg E, Koster RW, de Vries H, Beesems SG. The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation. Resuscitation 2016; 110:1-5. [PMID: 27751861 DOI: 10.1016/j.resuscitation.2016.08.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 08/05/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. MATERIALS AND METHODS Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. RESULTS In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27). CONCLUSION Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses.
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Affiliation(s)
| | - Rudolph W Koster
- Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands
| | | | - Stefanie G Beesems
- Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands
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Beck S, Ruhnke B, Issleib M, Daubmann A, Harendza S, Zöllner C. Analyses of inter-rater reliability between professionals, medical students and trained school children as assessors of basic life support skills. BMC MEDICAL EDUCATION 2016; 16:263. [PMID: 27717352 PMCID: PMC5054623 DOI: 10.1186/s12909-016-0788-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Training of lay-rescuers is essential to improve survival-rates after cardiac arrest. Multiple campaigns emphasise the importance of basic life support (BLS) training for school children. Trainings require a valid assessment to give feedback to school children and to compare the outcomes of different training formats. Considering these requirements, we developed an assessment of BLS skills using MiniAnne and tested the inter-rater reliability between professionals, medical students and trained school children as assessors. METHODS Fifteen professional assessors, 10 medical students and 111-trained school children (peers) assessed 1087 school children at the end of a CPR-training event using the new assessment format. Analyses of inter-rater reliability (intraclass correlation coefficient; ICC) were performed. RESULTS Overall inter-rater reliability of the summative assessment was high (ICC = 0.84, 95 %-CI: 0.84 to 0.86, n = 889). The number of comparisons between peer-peer assessors (n = 303), peer-professional assessors (n = 339), and peer-student assessors (n = 191) was adequate to demonstrate high inter-rater reliability between peer- and professional-assessors (ICC: 0.76), peer- and student-assessors (ICC: 0.88) and peer- and other peer-assessors (ICC: 0.91). Systematic variation in rating of specific items was observed for three items between professional- and peer-assessors. CONCLUSION Using this assessment and integrating peers and medical students as assessors gives the opportunity to assess hands-on skills of school children with high reliability.
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Affiliation(s)
- Stefanie Beck
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Bjarne Ruhnke
- The Medical Faculty of the University Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Malte Issleib
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Kilgannon JH, Kirchhoff M, Pierce L, Aunchman N, Trzeciak S, Roberts BW. Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital. Resuscitation 2016; 110:154-161. [PMID: 27666168 DOI: 10.1016/j.resuscitation.2016.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/23/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
Abstract
AIMS Recent guidelines for management of cardiac arrest recommend chest compression rates of 100-120 compressions/min. However, animal studies have found cardiac output to increase with rates up to 150 compressions/min. The objective of this study was to test the association between chest compression rates during cardiopulmonary resuscitation for in-hospital cardiac arrest (IHCA) and outcome. METHODS We conducted a prospective observational study at a single academic medical center. INCLUSION CRITERIA age≥18, IHCA, cardiopulmonary resuscitation performed. We analyzed chest compression rates measured by defibrillation electrodes, which recorded changes in thoracic impedance. The primary outcome was return of spontaneous circulation (ROSC). We used multivariable logistic regression to determine odds ratios for ROSC by chest compression rate categories (100-120, 121-140, >140 compressions/min), adjusted for chest compression fraction (proportion of time chest compressions provided) and other known predictors of outcome. We set 100-120 compressions/min as the reference category for the multivariable model. RESULTS We enrolled 222 consecutive patients and found a mean chest compression rate of 139±15. Overall 53% achieved ROSC; among 100-120, 121-140, and >140 compressions/min, ROSC was 29%, 64%, and 49% respectively. A chest compression rate of 121-140 compressions/min had the greatest likelihood of ROSC, odds ratio 4.48 (95% CI 1.42-14.14). CONCLUSIONS In this sample of adult IHCA patients, a chest compression rate of 121-140 compressions/min had the highest odds ratio of ROSC. Rates above the currently recommended 100-120 compressions/min may improve the chances of ROSC among IHCA patients.
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Affiliation(s)
- J Hope Kilgannon
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Michael Kirchhoff
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Lisa Pierce
- The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Nicholas Aunchman
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Stephen Trzeciak
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States; The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Brian W Roberts
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
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Rasmussen SE, Nebsbjerg MA, Krogh LQ, Bjørnshave K, Krogh K, Povlsen JA, Riddervold IS, Grøfte T, Kirkegaard H, Løfgren B. A novel protocol for dispatcher assisted CPR improves CPR quality and motivation among rescuers-A randomized controlled simulation study. Resuscitation 2016; 110:74-80. [PMID: 27658651 DOI: 10.1016/j.resuscitation.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/14/2016] [Accepted: 09/09/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emergency dispatchers use protocols to instruct bystanders in cardiopulmonary resuscitation (CPR). Studies changing one element in the dispatcher's protocol report improved CPR quality. Whether several changes interact is unknown and the effect of combining multiple changes previously reported to improve CPR quality into one protocol remains to be investigated. We hypothesize that a novel dispatch protocol, combining multiple beneficial elements improves CPR quality compared with a standard protocol. METHODS A novel dispatch protocol was designed including wording on chest compressions, using a metronome, regular encouragements and a 10-s rest each minute. In a simulated cardiac arrest scenario, laypersons were randomized to perform single-rescuer CPR guided with the novel or the standard protocol. PRIMARY OUTCOME a composite endpoint of time to first compression, hand position, compression depth and rate and hands-off time (maximum score: 22 points). Afterwards participants answered a questionnaire evaluating the dispatcher assistance. RESULTS The novel protocol (n=61) improved CPR quality score compared with the standard protocol (n=64) (mean (SD): 18.6 (1.4)) points vs. 17.5 (1.7) points, p<0.001. The novel protocol resulted in deeper chest compressions (mean (SD): 58 (12)mm vs. 52 (13)mm, p=0.02) and improved rate of correct hand position (61% vs. 36%, p=0.01) compared with the standard protocol. In both protocols hands-off time was short. The novel protocol improved motivation among rescuers compared with the standard protocol (p=0.002). CONCLUSIONS Participants guided with a standard dispatch protocol performed high quality CPR. A novel bundle of care protocol improved CPR quality score and motivation among rescuers.
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Affiliation(s)
- Stinne Eika Rasmussen
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Lise Qvirin Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Katrine Bjørnshave
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Kristian Krogh
- Center for Health Sciences Education, Aarhus University, Palle Juul-Jensens Boulevard 82, Building B, 8200 Aarhus N, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jonas Agerlund Povlsen
- Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 9, 8200 Aarhus N, Denmark
| | - Ingunn Skogstad Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 1st floor, 8200 Aarhus N, Denmark
| | - Thorbjørn Grøfte
- Department of Anaesthesiology and Intensive Care, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 30, 8000 Aarhus C, Denmark; Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Denmark.
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Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6418710. [PMID: 27668257 PMCID: PMC5030397 DOI: 10.1155/2016/6418710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
Objective. There are many smartphone-based applications (apps) for cardiopulmonary resuscitation (CPR) training. We investigated the conformity and the learnability/usability of these apps for CPR training and real-life supports. Methods. We conducted a mixed-method, sequential explanatory study to assess CPR training apps downloaded on two apps stores in South Korea. Apps were collected with inclusion criteria as follows, Korean-language instruction, training features, and emergency supports for real-life incidents, and analyzed with two tests; 15 medical experts evaluated the apps' contents according to current Basic Life Support guidelines in conformity test, and 15 nonmedical individuals examined the apps using System Usability Scale (SUS) in the learnability/usability test. Results. Out of 79 selected apps, five apps were included and analyzed. For conformity (ICC, 0.95, p < 0.001), means of all apps were greater than 12 of 20 points, indicating that they were well designed according to current guidelines. Three of the five apps yielded acceptable level (greater than 68 of 100 points) for learnability/usability. Conclusion. All the included apps followed current BLS guidelines and a majority offered acceptable learnability/usability for layperson. Current and developmental smartphone-based CPR training apps should include accurate CPR information and be easy to use for laypersons that are potential rescuers in real-life incidents. For Clinical Trials. This is a clinical trial, registered at the Clinical Research Information Service (CRIS, cris.nih.go.kr), number KCT0001840.
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Involvement of elite athletes in a CPR educational program for seventh grade students did not influence practical CPR skills or willingness to act: Report from a cluster-randomized trial. Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hwang SO, Cha KC, Kim K, Jo YH, Chung SP, You JS, Shin J, Lee HJ, Park YS, Kim S, Choi SC, Park EJ, Kim WY, Seo DW, Moon S, Han G, Choi HS, Kang H, Park SM, Kwon WY, Choi E. A Randomized Controlled Trial of Compression Rates during Cardiopulmonary Resuscitation. J Korean Med Sci 2016; 31:1491-8. [PMID: 27510396 PMCID: PMC4974194 DOI: 10.3346/jkms.2016.31.9.1491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/13/2016] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED The objective of this study was to compare the efficacy of cardiopulmonary resuscitation (CPR) with 120 compressions per minute (CPM) to CPR with 100 CPM in patients with non-traumatic out-of-hospital cardiac arrest. We randomly assigned patients with non-traumatic out-of-hospital cardiac arrest into two groups upon arrival to the emergency department (ED). The patients received manual CPR either with 100 CPM (CPR-100 group) or 120 CPM (CPR-120 group). The primary outcome measure was sustained restoration of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, one-month survival, and one-month survival with good functional status. Of 470 patients with cardiac arrest, 136 patients in the CPR-100 group and 156 patients in the CPR-120 group were included in the final analysis. A total of 69 patients (50.7%) in the CPR-100 group and 67 patients (42.9%) in the CPR-120 group had ROSC (absolute difference, 7.8% points; 95% confidence interval [CI], -3.7 to 19.2%; P = 0.183). The rates of survival discharge from the hospital, one-month survival, and one-month survival with good functional status were not different between the two groups (16.9% vs. 12.8%, P = 0.325; 12.5% vs. 6.4%, P = 0.073; 5.9% vs. 2.6%, P = 0.154, respectively). We did not find differences in the resuscitation outcomes between those who received CPR with 100 CPM and those with 120 CPM. However, a large trial is warranted, with adequate power to confirm a statistically non-significant trend toward superiority of CPR with 100 CPM. ( CLINICAL TRIAL REGISTRATION INFORMATION www.cris.nih.go.kr, cris.nih.go.kr number, KCT0000231).
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Affiliation(s)
- Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University Kangnam Severance Hospital, Seoul, Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University Kangnam Severance Hospital, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hui Jai Lee
- Department of Emergency Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University Severance Hospital, Seoul, Korea
| | - Seunghwan Kim
- Department of Emergency Medicine, Yonsei University Severance Hospital, Seoul, Korea
| | - Sang Cheon Choi
- Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, Ulsan University, Seoul, Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Gapsu Han
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Hallym University Saint Sacred Hospital, Anyang, Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eunhee Choi
- Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Kaldırım U, Toygar M, Karbeyaz K, Arzıman I, Tuncer SK, Eyi YE, Eroglu M. Complications of cardiopulmonary resuscitation in non-traumatic cases and factors affecting complications. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2015.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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López-González A, Sánchez-López M, Garcia-Hermoso A, López-Tendero J, Rabanales-Sotos J, Martínez-Vizcaíno V. Muscular fitness as a mediator of quality cardiopulmonary resuscitation. Am J Emerg Med 2016; 34:1845-9. [DOI: 10.1016/j.ajem.2016.06.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022] Open
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Zhou XL, Sheng LP, Wang J, Li SQ, Wang HL, Ni SZ, Jiang S, Zhao Y, Shen J, Yang QS. Effect of bed width on the quality of compressions in simulated resuscitation: a randomized crossover manikin study. Am J Emerg Med 2016; 34:2272-2276. [PMID: 27592725 DOI: 10.1016/j.ajem.2016.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the effects of bed width on the quality of chest compressions during simulated in-hospital resuscitation. METHODS Each candidate performed two 2-minute cycles of compression-only cardiopulmonary resuscitation on an adult manikin placed on either an emergency stretcher (narrow bed) or a standard hospital bed (wide bed) in random order at 1 day intervals. We conducted subjective assessments of cardiopulmonary resuscitation quality and rescuer fatigue at the end of each session, using surveys. RESULTS There were no significant differences between narrow and wide bed sessions in either mean depth or the percentage of compressions with adequate depth (P=.56 and .58, respectively). The mean rate of compressions and the percentage of compressions with adequate rate were also similar between sessions (P=.24 and .27, respectively). However, the percentage of correct hand position and complete chest recoil was significantly higher in the narrow bed session than in the wide bed session (P=.02 and .02, respectively). In addition, survey results showed that rescuers felt more comfortable and less exhausted in the narrow bed session compared with the wide bed session (P<.001 and < .001). CONCLUSIONS When rescuers performed chest compressions on an emergency stretcher, chest compression quality increased, and the fatigue of rescuers decreased compared with a standard hospital bed. Therefore, we propose a narrow bed for critically ill inpatients with high risk of cardiac arrest.
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Affiliation(s)
- Xian-Long Zhou
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Li-Ping Sheng
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Jing Wang
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Shun-Qing Li
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Huang-Lei Wang
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Shao-Zhou Ni
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Shan Jiang
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Yan Zhao
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
| | - Jun Shen
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Qi-Sheng Yang
- Emergency Centre, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
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Abstract
Introduction Despite numerous efforts, out-of-hospital cardiac arrest (OHCA) survival has not significantly increased in recent decades. The first telephone-assisted cardiopulmonary resuscitation (T-CPR) studies were published in the 1980s, but only in the last decade has T‑CPR been implemented in dispatch centers. T‑CPR is still not available in all dispatch centers and no national or international T‑CPR recommendations are available. Methods Studies from PubMed were identified and evaluated. Preliminary information from the European Dispatch Center Survey (EDiCeS) is also included. Results In all, 42 studies were included. T‑CPR is implemented in 87.6 % of those dispatch centers which have joined the not-yet published EDiCeS. According to German Resuscitation Registry data, about 10 % of OHCA patients received T‑CPR in 2014. Agonal breathing is the leading cause for nonrecognition of OHCA by the dispatcher. Sensitivity of OHCA recognition by the dispatcher is about 75 %, whereby 8–45 % of these patients were not in cardiac arrest. The time interval from call to first compression is 140–328 s. Instructing rescue breathing by telephone is time consuming, leads to extensive hands-off times, and often to ineffective ventilation; therefore, rescue breathing is not indicated in adults with primary cardiac arrest. Studies showed improved survival with standardized T‑CPR implementation. Conclusion T-CPR is established in many dispatch centers. However, emergency call interrogation and T‑CPR vary between dispatch centers and are often performed without evaluation. International recommendations with standardized quality control are necessary and may lead to improved survival.
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Hyldmo PK, Horodyski MB, Conrad BP, Dubose DN, Røislien J, Prasarn M, Rechtine GR, Søreide E. Safety of the lateral trauma position in cervical spine injuries: a cadaver model study. Acta Anaesthesiol Scand 2016; 60:1003-11. [PMID: 26952653 PMCID: PMC5069596 DOI: 10.1111/aas.12714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Abstract
Background Endotracheal intubation is not always an option for unconscious trauma patients. Prehospital personnel are then faced with the dilemma of maintaining an adequate airway without risking deleterious movement of a potentially unstable cervical spine. To address these two concerns various alternatives to the classical recovery position have been developed. This study aims to determine the amount of motion induced by the recovery position, two versions of the HAINES (High Arm IN Endangered Spine) position, and the novel lateral trauma position (LTP). Method We surgically created global cervical instability between the C5 and C6 vertebrae in five fresh cadavers. We measured the rotational and translational (linear) range of motion during the different maneuvers using an electromagnetic tracking device and compared the results using a general linear mixed model (GLMM) for regression. Results In the recovery position, the range of motion for lateral bending was 11.9°. While both HAINES positions caused a similar range of motion, the motion caused by the LTP was 2.6° less (P = 0.037). The linear axial range of motion in the recovery position was 13.0 mm. In comparison, the HAINES 1 and 2 positions showed significantly less motion (−5.8 and −4.6 mm, respectively), while the LTP did not (−4.0 mm, P = 0.067). Conclusion Our results indicate that in unconscious trauma patients, the LTP or one of the two HAINES techniques is preferable to the standard recovery position in cases of an unstable cervical spine injury.
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Affiliation(s)
- P. K. Hyldmo
- Department of Research Norwegian Air Ambulance Foundation Drøbak Norway
- Department of Anesthesiology and Intensive Care Sørlandet Hospital Kristiansand Norway
| | - M. B. Horodyski
- Department of Orthopedics & Rehabilitation University of Florida Gainesville Florida USA
| | - B. P. Conrad
- Department of Orthopedics & Rehabilitation University of Florida Gainesville Florida USA
- Nike Sport Research Lab Nike Inc. Beaverton Oregon USA
| | - D. N. Dubose
- Department of Orthopedics & Rehabilitation University of Florida Gainesville Florida USA
| | - J. Røislien
- Department of Health Studies University of Stavanger Stavanger Norway
- Department of Biostatistics University of Oslo Oslo Norway
| | - M. Prasarn
- Department of Orthopedics University of Texas Huston Texas USA
| | - G. R. Rechtine
- Bay Pines VA Hospital System Bay Pines Florida USA
- Department of Orthopedic Surgery University of South Florida Tampa Florida USA
| | - E. Søreide
- Department of Anesthesiology and Intensive Care Stavanger University Hospital Stavanger Norway
- Network for Medical Sciences University of Stavanger Stavanger Norway
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Beskind DL, Stolz U, Thiede R, Hoyer R, Burns W, Brown J, Ludgate M, Tiutan T, Shane R, McMorrow D, Pleasants M, Panchal AR. Viewing a brief chest-compression-only CPR video improves bystander CPR performance and responsiveness in high school students: A cluster randomized trial. Resuscitation 2016; 104:28-33. [DOI: 10.1016/j.resuscitation.2016.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/12/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
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125
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Hospital implementation of resuscitation guidelines and review of CPR training programmes. Eur J Emerg Med 2016; 23:232-4. [DOI: 10.1097/mej.0000000000000296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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126
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A randomised control trial to compare retention rates of two cardiopulmonary resuscitation instruction methods in the novice. Resuscitation 2016; 103:82-87. [DOI: 10.1016/j.resuscitation.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/25/2016] [Accepted: 03/04/2016] [Indexed: 11/19/2022]
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127
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Kim TH, Hong KJ, Sang Do S, Kim CH, Song SW, Song KJ, Ro YS, Ahn KO, Jang DB. Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator. Am J Emerg Med 2016; 34:1604-9. [PMID: 27318749 DOI: 10.1016/j.ajem.2016.05.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Manual cardiopulmonary resuscitation (CPR) during vertical transport in small elevators using standard stretcher for out-of-hospital cardiac arrest can raise concerns with diminishing quality. Mechanical CPR on a reducible stretcher (RS-CPR) that can be shortened in the length was tested to compare the CPR quality with manual CPR on a standard stretcher (SS-CPR). METHODS A randomized crossover manikin simulation was designed. Three teams of emergency medical technicians were recruited to perform serial CPR simulations using two different protocols (RS-CPR and SS-CPR) according to a randomization; the first 6 minutes of manual CPR at the scene was identical for both scenarios and two different protocols during vertical transport in a small elevator followed on a basis of cross-over assignment. The LUCAS-2 Chest Compression System (Zolife AB, Lund, Sweden) was used for RS-CPR. CPR quality was measured using a resuscitation manikin (Resusci Anne QCPR, Laerdal Medical, Stavanger, Norway) in terms of no flow fraction, compression depth, and rate (median and IQR). RESULTS A total of 42 simulations were analyzed. CPR quality did not differ significantly at the scene. No flow fraction (%) was significantly lower when the stretcher was moving in RS-CPR then SS-CPR (36.0 (33.8-38.7) vs 44.0 (36.8-54.4), P< .01). RS-CPR showed significantly better quality than SS-CPR; 93.2 (50.6-95.6) vs 14.8 (0-20.8) for adequate depth (P< 0.01), and 97.5 (96.6-98.2) vs 68.9(43.4-78.5) for adequate rate (P< .01). CONCLUSION Mechanical CPR on a reducible stretcher during vertical transport showed significant improvement in CPR quality in terms of no-flow fraction, compression depth, and rate compared with manual CPR on a standard stretcher.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Shin Sang Do
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Chu Hyun Kim
- Department of Emergency Medicine, Inje University Seoul Pak Hospital, Seoul, Korea.
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University Hospital, Jejudo, Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Ki Ok Ahn
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Dayea Beatrice Jang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
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Vahedian-Azimi A, Hajiesmaeili M, Amirsavadkouhi A, Jamaati H, Izadi M, Madani SJ, Hashemian SMR, Miller AC. Effect of the Cardio First Angel™ device on CPR indices: a randomized controlled clinical trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:147. [PMID: 27184664 PMCID: PMC4869179 DOI: 10.1186/s13054-016-1296-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 04/13/2016] [Indexed: 11/11/2022]
Abstract
Background A number of cardiopulmonary resuscitation (CPR) adjunct devices have been developed to improve the consistency and quality of manual chest compressions. We investigated whether a CPR feedback device would improve CPR quality and consistency, as well as patient survival. Methods We conducted a randomized controlled study of patients undergoing CPR for cardiac arrest in the mixed medical-surgical intensive care units of four academic teaching hospitals. Patients were randomized to receive either standard manual CPR or CPR using the Cardio First Angel™ CPR feedback device. Recorded variables included guideline adherence, CPR quality, return of spontaneous circulation (ROSC) rates, and CPR-associated morbidity. Results A total of 229 subjects were randomized; 149 were excluded; and 80 were included. Patient demographics were similar. Adherence to published CPR guidelines and CPR quality was significantly improved in the intervention group (p < 0.0001), as were ROSC rates (72 % vs. 35 %; p = 0.001). A significant decrease was observed in rib fractures (57 % vs. 85 %; p = 0.02), but not sternum fractures (5 % vs. 17 %; p = 0.15). Conclusions Use of the Cardio First Angel™ CPR feedback device improved adherence to published CPR guidelines and CPR quality, and it was associated with increased rates of ROSC. A decrease in rib but not sternum fractures was observed with device use. Further independent prospective validation is warranted to determine if these results are reproducible in other acute care settings. Trial registration ClinicalTrials.gov identifier: NCT02394977. Registered on 5 Mar 2015.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Loghman Clinical Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Jamaati
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed J Madani
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed M R Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andrew C Miller
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506-9149, USA.
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Oya S, Shinjo T, Fujii Y, Kamo J, Teruya H, Kinoshita H. CPR related thoracic injury: a comparison of CPR guidelines between 2005 and 2010. Acute Med Surg 2016; 3:351-355. [PMID: 29123811 DOI: 10.1002/ams2.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/05/2016] [Indexed: 11/11/2022] Open
Abstract
Aim The objective of this study was to investigate the incidence and characteristics of thoracic injuries associated with cardiopulmonary resuscitation (CPR) performed under the 2005 and the 2010 guidelines. Methods We evaluated patients who had an out-of-hospital cardiac arrest in 2010 (2005 group) and 2012 (2010 group). We analyzed the incidence and characteristics of rib fractures and pneumothoraces received during CPR as determined by medical records and image studies. Results Two hundred and ninety-two patients in the 2005 group and 243 in the 2010 group were enrolled. The number of patients with rib fractures was greater in the 2010 group than in the 2005 group (123 [42.1%] versus 167 [68.7%], P < 0.001), and the number of pneumothorax patients with rib fractures was also higher (8 [2.7%] versus 21 [8.6%], P = 0.004). Of the 21 patients, four had a tension pneumothorax. The anterior-posterior diameter of the chest (APD) was smaller in patients with a pneumothorax and rib fractures than those without the injuries (166.0 mm [standard deviation 22.8] versus 176.2 mm [standard deviation 21.0], P = 0.04), and the APD for patients of Japanese descent was smaller than that of patients of European descent by more than 50 mm. Conclusion The number of rib fractures and pneumothoraces received during CPR increased significantly under the 2010 guidelines when compared with the 2005 guidelines. As the APD for patients of Japanese descent is smaller than that of patients of European descent, Japanese medical facilities need to be prepared for possible fatal adverse events associated with CPR under the current international guidelines.
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Affiliation(s)
- Seiro Oya
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Takafumi Shinjo
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Yasuhiro Fujii
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Jun Kamo
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Hideki Teruya
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Hirohisa Kinoshita
- Department of Emergency and Critical Care Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
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Nord A, Svensson L, Hult H, Kreitz-Sandberg S, Nilsson L. Effect of mobile application-based versus DVD-based CPR training on students' practical CPR skills and willingness to act: a cluster randomised study. BMJ Open 2016; 6:e010717. [PMID: 27130166 PMCID: PMC4853996 DOI: 10.1136/bmjopen-2015-010717] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim was to compare students' practical cardiopulmonary resuscitation (CPR) skills and willingness to perform bystander CPR, after a 30 min mobile application (app)-based versus a 50 min DVD-based training. SETTINGS Seventh grade students in two Swedish municipalities. DESIGN A cluster randomised trial. The classes were randomised to receive app-based or DVD-based training. Willingness to act and practical CPR skills were assessed, directly after training and at 6 months, by using a questionnaire and a PC Skill Reporting System. Data on CPR skills were registered in a modified version of the Cardiff test, where scores were given in 12 different categories, adding up to a total score of 12-48 points. Training and measurements were performed from December 2013 to October 2014. PARTICIPANTS 63 classes or 1232 seventh grade students (13-year-old) were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary end point was the total score of the modified Cardiff test. The individual variables of the test and self-reported willingness to make a life-saving intervention were secondary end points. RESULTS The DVD-based group was superior to the app-based group in CPR skills; a total score of 36 (33-38) vs 33 (30-36) directly after training (p<0.001) and 33 (30-36) and 31 (28-34) at 6 months (p<0.001), respectively. At 6 months, the DVD group performed significantly better in 8 out of 12 CPR skill components. Both groups improved compression depth from baseline to follow-up. If a friend suffered cardiac arrest, 78% (DVD) versus 75% (app) would do compressions and ventilations, whereas only 31% (DVD) versus 32% (app) would perform standard CPR if the victim was a stranger. CONCLUSIONS At 6 months follow-up, the 50 min DVD-based group showed superior CPR skills compared with the 30 min app-based group. The groups did not differ in regard to willingness to make a life-saving effort.
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Affiliation(s)
- Anette Nord
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Håkan Hult
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | | | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Zinckernagel L, Malta Hansen C, Rod MH, Folke F, Torp-Pedersen C, Tjørnhøj-Thomsen T. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools? A qualitative study. BMJ Open 2016; 6:e010481. [PMID: 27113236 PMCID: PMC4853997 DOI: 10.1136/bmjopen-2015-010481] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across the interviews. SETTING 8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals. PARTICIPANTS The study population comprised 25 participants, 9 school leadership members and 16 teachers. RESULTS School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits. CONCLUSIONS To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise teachers with CPR training kits.
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Affiliation(s)
- Line Zinckernagel
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Morten Hulvej Rod
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
- Emergency Medical Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Tine Tjørnhøj-Thomsen
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Nestaas S, Stensæth KH, Rosseland V, Kramer-Johansen J. Radiological assessment of chest compression point and achievable compression depth in cardiac patients. Scand J Trauma Resusc Emerg Med 2016; 24:54. [PMID: 27103035 PMCID: PMC4840890 DOI: 10.1186/s13049-016-0245-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Using magnetic resonance imaging (MRI) to relate cardiovascular structures to surface anatomy in a population relevant to cardiac arrest victims, relate the external thoracic anterior-posterior (AP) diameter (APEXTERNAL) and blood-filled structures to recommended chest compression depths, and define an optimal compression point (OCP). Methods MRI axial scans of referred patients were analysed. We defined origo as the skin surface of the centre of sternum in the internipple line. The blood-filled structures beneath origo were identified and the sum of their inner diameters (APBLOOD) and APEXTERNAL were measured. We defined OCP based on the image with maximum compressible left and right ventricle and where LVOT was not present. We measured the distance from origo to OCP. Results Consecutive patients, mean (SD), age 52 (17) years, 110 (76 %) males, were categorized: cardiac disease (n = 74), aortic disease (n = 13), no findings/study patient (included in another study) (n = 57). The structure LVOT/aortic valve (AV)/aortic root was present in 46 % of patients with cardiac disease vs. 19 % of patients with no findings. APEXTERNAL for males and females was 25 (2) cm and 22 (2) cm, and APBLOOD 6.5 cm (2) and 4.7 cm (2), respectively. Distance from origo to OCP was 32 (11) mm to the left and 16 (21) mm caudally. Discussion LVOT/AV/aortic root was present beneath the origo in almost half the patients with cardiac disease. Recommended chest compression depths exceeded the anterior-posterior diameter of blood-filled structures in more than half of the females. OCP was found 3 cm left of the origo. Conclusions Based on our study, individualized compression point and depth could be further studied in a prospective, clinical study. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0245-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sverre Nestaas
- Department of Anaesthesiology, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway.
| | - Knut Haakon Stensæth
- Department of Radiology and Nuclear Medicine and Institute of Circulation and Imaging, St Olavs University Hospital and Norwegian University of Science and Technology, Po Box 3250, Sluppen, N-7006, Trondheim, Norway
| | - Vigdis Rosseland
- Intervention- and Sonography Unit, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway
| | - Jo Kramer-Johansen
- Department of Anaesthesiology, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway.,Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital and University of Oslo, Po Box 4956, Nydalen, N-0424, Oslo, Norway
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Dupont V, Rougé-Maillart C, Gaudin A, Jeanneteau A, Jousset N, Malbranque S. Left Diaphragm Laceration Due to Cardiopulmonary Resuscitation. J Forensic Sci 2016; 61:1135-1138. [DOI: 10.1111/1556-4029.13086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/06/2015] [Accepted: 10/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Vincent Dupont
- Lunam Université; Angers France
- Department of Forensic Medicine; University Hospital - Angers; 49933 Angers Cedex 09 France
| | - Clotilde Rougé-Maillart
- Lunam Université; Angers France
- Department of Forensic Medicine; University Hospital - Angers; 49933 Angers Cedex 09 France
- Lunam Université; GEROM-LHEA; IRIS-IBS Institut de Biologie en santé; CHU Angers; 49933 Angers Cedex 09 France
| | - Arnaud Gaudin
- Lunam Université; Angers France
- Department of Forensic Medicine; University Hospital - Angers; 49933 Angers Cedex 09 France
| | - Audrey Jeanneteau
- Department of Anesthesiology and Reanimation; University Hospital - Angers; 49933 Angers Cedex 09 France
| | - Nathalie Jousset
- Lunam Université; Angers France
- Department of Forensic Medicine; University Hospital - Angers; 49933 Angers Cedex 09 France
| | - Stéphane Malbranque
- Lunam Université; Angers France
- Department of Forensic Medicine; University Hospital - Angers; 49933 Angers Cedex 09 France
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134
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Klein HH. [New guidelines on resuscitation in adults: What has changed?]. Herzschrittmacherther Elektrophysiol 2016; 27:2-5. [PMID: 26754534 DOI: 10.1007/s00399-015-0412-4] [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: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
In October 2015, new guidelines for cardiopulmonary resuscitation (CPR) were published, which represent a revision of the guidelines 2010. The new recommendations are based on an update of knowledge on resuscitation, which was evaluated for the first time by GRADE (Grading of Recommendations Assessment, Development and Evaluation). The key messages of the guidelines 2010 were retained in 2015. Adult basic life support consists of a sequence of 30 chest compressions at a rate of 100-120/min with a depth of 5 to maximally 6 cm and 2 ventilations. As soon as possible, an automated external defibrillator (AED) should be applied. Interruptions of chest compressions should be minimized. To improve bystander CPR emergency medical dispatchers should diagnose cardiac arrest when informed about unconscious persons not breathing normally. In this case, emergency medical staff should inform bystanders to resuscitate with compression only CPR until the arrival of an emergency team. In postresuscitation care, mild hypothermia (body temperature 32-34 °C) has been replaced by targeted temperature management in unconscious patients. Now, the guidelines recommend a constant body temperature between 32-36 °C for at least 24 h. Fever should be prevented or treated.
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Affiliation(s)
- Hermann H Klein
- Helios Klinikum Warburg, Langwiesen Str. 13, 55743, Idar-Oberstein, Deutschland.
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135
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Oh J, Lim TH, Cho Y, Kang H, Kim W, Chee Y, Song Y, Kim IY, Lee J. Training a Chest Compression of 6-7 cm Depth for High Quality Cardiopulmonary Resuscitation in Hospital Setting: A Randomised Controlled Trial. Yonsei Med J 2016; 57:505-11. [PMID: 26847307 PMCID: PMC4740547 DOI: 10.3349/ymj.2016.57.2.505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE During cardiopulmonary resuscitation (CPR), chest compression (CC) depth is influenced by the surface on which the patient is placed. We hypothesized that training healthcare providers to perform a CC depth of 6-7 cm (instead of 5-6 cm) on a manikin placed on a mattress during CPR in the hospital might improve their proper CC depth. MATERIALS AND METHODS This prospective randomised controlled study involved 66 premedical students without CPR training. The control group was trained to use a CC depth of 5-6 cm (G 5-6), while the experimental group was taught to use a CC depth of 6-7 cm (G 6-7) with a manikin on the floor. All participants performed CCs for 2 min on a manikin that was placed on a bed 1 hour and then again 4 weeks after the training without a feedback. The parameters of CC quality (depth, rate, % of accurate depth) were assessed and compared between the 2 groups. RESULTS Four students were excluded due to loss to follow-up and recording errors, and data of 62 were analysed. CC depth and % of accurate depth were significantly higher among students in the G 6-7 than G 5-6 both 1 hour and 4 weeks after the training (p<0.001), whereas CC rate was not different between two groups (p>0.05). CONCLUSION Training healthcare providers to perform a CC depth of 6-7 cm could improve quality CC depth when performing CCs on patients who are placed on a mattress during CPR in a hospital setting.
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Affiliation(s)
- Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.
| | - Youngsuk Cho
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Youngjoon Chee
- School of Electrical Engineering, University of Ulsan, Ulsan, Korea
| | - Yeongtak Song
- School of Electrical Engineering, University of Ulsan, Ulsan, Korea
| | - In Young Kim
- Department of Biomedical Engineering Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Lukas RP, Van Aken H, Mölhoff T, Weber T, Rammert M, Wild E, Bohn A. Kids save lives: a six-year longitudinal study of schoolchildren learning cardiopulmonary resuscitation: Who should do the teaching and will the effects last? Resuscitation 2016; 101:35-40. [PMID: 26868079 DOI: 10.1016/j.resuscitation.2016.01.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/18/2015] [Accepted: 01/25/2016] [Indexed: 02/06/2023]
Abstract
AIMS This prospective longitudinal study over 6 years compared schoolteachers and emergency physicians as resuscitation trainers for schoolchildren. It also investigated whether pupils who were trained annually for 3 years retain their resuscitation skills after the end of this study. METHODS A total of 261 pupils (fifth grade) at two German grammar schools received resuscitation training by trained teachers or by emergency physicians. The annual training events stopped after 3 years in one group and continued for 6 years in a second group. We measured knowledge about resuscitation (questionnaire), chest compression rate (min(-1)), chest compression depth (mm), ventilation rate (min(-1)), ventilation volume (mL), self-efficacy (questionnaire). Their performance was evaluated after 1, 3 and 6 years. RESULTS The training events increased the pupils' knowledge and practical skills. When trained by teachers, the pupils achieved better results for knowledge (92.86% ± 8.38 vs. 90.10% ± 8.63, P=0.04) and ventilation rate (4.84/min ± 4.05 vs. 3.76/min ± 2.37, P=0.04) than when they were trained by emergency physicians. There were no differences with regard to chest compression rate, depth, ventilation volume, or self-efficacy at the end of the study. Knowledge and skills after 6 years were equivalent in the group with 6 years training compared with 3 years training. CONCLUSIONS Trained teachers can provide adequate resuscitation training in schools. Health-care professionals are not mandatory for CPR training (easier for schools to implement resuscitation training). The final evaluation after 6 years showed that resuscitation skills are retained even when training is interrupted for 3 years.
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Affiliation(s)
- Roman-Patrik Lukas
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany.
| | - Hugo Van Aken
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Mölhoff
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Katholische Stiftung Marienhospital, Aachen, Germany
| | - Thomas Weber
- Department of Anaesthesiology and Intensive Care, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany
| | - Monika Rammert
- Faculty of Psychology and Sports Sciences, University of Bielefeld, Bielefeld, Germany
| | - Elke Wild
- Faculty of Psychology and Sports Sciences, University of Bielefeld, Bielefeld, Germany
| | - Andreas Bohn
- City of Münster Fire Department and Emergency Services, Münster, Germany
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Abstract
PURPOSE OF REVIEW Quick initiation of basic life support (BLS) by laypersons is one of the most successful strategies in the fight against sudden cardiac death. In developed countries, cardiac arrest is still a major contributor to avoidable death, and despite the fact that more than 50% of all cardiac arrests are witnessed, layperson BLS is performed in less than 20%. To improve this situation, BLS training in schools has been established. RECENT FINDINGS Cardiopulmonary resuscitation (CPR) instruction including the use of automatic external defibrillators (AEDs) has shown to be feasible even for young schoolchildren, and there is an indication that respective programmes are effective to enhance patient outcome on a population basis. Earlier training may even lead to more sustainable results; however, it is reasonable to implement adjusted curricula for different child ages. The programme 'Kids Save Lives' recently endorsed by the WHO will help promoting school-based BLS training worldwide demanding education on CPR for all pupils starting at least at age 12. SUMMARY Resuscitation training in schools can help to increase the amount of BLS-trained population. Social skills of pupils can be improved and training can be successfully implemented independently of the pupils' age and physique.
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138
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Alonso E, Aramendi E, Daya M, Irusta U, Chicote B, Russell JK, Tereshchenko LG. Circulation detection using the electrocardiogram and the thoracic impedance acquired by defibrillation pads. Resuscitation 2015; 99:56-62. [PMID: 26705970 DOI: 10.1016/j.resuscitation.2015.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/06/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Abstract
AIM To develop and evaluate a method to detect circulation in the presence of organized rhythms (ORs) during resuscitation using signals acquired by defibrillation pads. METHODS Segments containing electrocardiogram (ECG) and thoracic impedance (TI) signals free of artifacts were used. The ECG corresponded to ORs classified as pulseless electrical activity (PEA) or pulse-generating rhythm (PR). A first dataset containing 1091 segments was split into training and test sets to develop and validate the circulation detector. The method processed ECG and TI to obtain the impedance circulation component (ICC). Morphological features were extracted from ECG and ICC, and combined into a classifier to discriminate between PEA and PR. The performance of the method was evaluated in terms of sensitivity (PR) and specificity (PEA). A second dataset (86 segments from different patients) was used to assess two application of the method: confirmation of arrest by recognizing absence of circulation during ORs and detection of return of spontaneous circulation (ROSC) during resuscitation. In both cases, time to confirmation of arrest/ROSC was determined. RESULTS The method showed a sensitivity/specificity of 92.1%/90.3% and 92.2%/91.9% for training and test sets respectively. The method confirmed cardiac arrest with a specificity of 93.3% with a median delay of 0s after the first OR annotation. ROSC was detected with a sensitivity of 94.4% with a median delay of 57s from ROSC onset. CONCLUSION The method showed good performance, and can be reliably used to distinguish perfusing from non-perfusing ORs.
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Affiliation(s)
- Erik Alonso
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - Elisabete Aramendi
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University, 97239-3098 Portland, OR, United States
| | - Unai Irusta
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - Beatriz Chicote
- Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain
| | - James K Russell
- Department of Emergency Medicine, Oregon Health & Science University, 97239-3098 Portland, OR, United States
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, 97239-3098 Portland, OR, United States
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Barcala-Furelos R, Szpilman D, Palacios-Aguilar J, Costas-Veiga J, Abelairas-Gomez C, Bores-Cerezal A, López-García S, Rodríguez-Nuñez A. Assessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning. Am J Emerg Med 2015; 34:480-5. [PMID: 26782793 DOI: 10.1016/j.ajem.2015.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 11/27/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance. METHOD A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards. RESULTS Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube. CONCLUSION The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.
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Affiliation(s)
- Roberto Barcala-Furelos
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain; CLINURSID Research Group, Departamento de Enfermería, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; IDRA, International Drowning Research Alliance, Rio de Janeiro, Brazil
| | - David Szpilman
- IDRA, International Drowning Research Alliance, Rio de Janeiro, Brazil; Brazilian Lifesaving Society (SOBRASA), Rio de Janeiro, Brazil; Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
| | | | - Javier Costas-Veiga
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain; Faculty of Health Sciences, European Atlantic University, Santander, Spain
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group, Departamento de Enfermería, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Faculty of Health Sciences, European Atlantic University, Santander, Spain
| | | | | | - Antonio Rodríguez-Nuñez
- CLINURSID Research Group, Departamento de Enfermería, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Pediatric Area, Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Fluid-Fluid Level and Pericardial Hyperdense Ring Appearance Findings on Unenhanced Postmortem CT Can Differentiate Between Postmortem and Antemortem Pericardial Hemorrhage. AJR Am J Roentgenol 2015; 205:W568-77. [DOI: 10.2214/ajr.15.14808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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141
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Ecker H, Schroeder D, Böttiger B. “Kids save lives” – School resuscitation programs worldwide and WHO initiative for this. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Manual versus Mechanical Chest Compressions on Surfaces of Varying Softness with or without Backboards: A Randomized, Crossover Manikin Study. J Emerg Med 2015; 50:594-600.e1. [PMID: 26607696 DOI: 10.1016/j.jemermed.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/31/2015] [Accepted: 10/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chest compression quality is decisive for overall outcome after cardiac arrest. Chest compression depth may decrease when cardiopulmonary resuscitation (CPR) is performed on a mattress, and the use of a backboard does not necessarily improve compression depth. Mechanical chest compression devices may overcome this problem. OBJECTIVES We sought to investigate the effectiveness of manual chest compressions both with and without a backboard compared to mechanical CPR performed on surfaces of different softness. METHODS Twenty-four advanced life support (ALS)-certified rescuers were enrolled. LUCAS2 (Physio-Control, Redmond, WA) delivers 52 ± 2 mm deep chest compressions and active decompressions back to the neutral position (frequency 102 min(-1); duty cycle, 50%). This simulated CPR scenario was performed on a Resusci-Anne manikin (Laerdal, Stavanger, Norway) that was lying on 3 different surfaces: 1) a concrete floor, 2) a firm standard mattress, and 3) a pressure-relieving mattress. Data were recorded by the Laerdal Skill Reporting System. RESULTS Manual chest compression with or without a backboard were performed correctly less often than mechanical chest compressions (floor: 33% [interquartile range {IQR}, 27-48%] vs. 90% [IQR, 86-94%], p < 0.001; standard mattress: 32% [IQR, 20-45%] vs. 27% [IQR, 14-46%] vs. 91% [IQR, 51-94%], p < 0.001; and pressure-relieving mattress 29% [IQR, 17-49%] vs. 30% [IQR, 17-52%] vs. 91% [IQR, 87-95%], p < 0.001). The mean compression depth on both mattresses was deeper with mechanical chest compressions (floor: 53 mm [range, 47-57 mm] vs. 56 mm [range, 54-57 mm], p = 0.003; standard mattress: 50 mm [range, 44-55 mm] vs. 51 mm [range, 47-55 mm] vs. 55 mm [range, 54-58 mm], p < 0.001; and pressure-relieving mattress: 49 mm [range, 44-55 mm] vs. 50 mm [range, 44-53 mm] vs. 55 mm [range, 55-56 mm], p < 0.001). In this ∼6-min scenario, the mean hands-off time was ∼15 to 20 s shorter in the manual CPR scenarios. CONCLUSIONS In this experimental study, only ∼30% of manual chest compressions were performed correctly compared to ∼90% of mechanical chest compressions, regardless of the underlying surface. Backboard use did not influence the mean compression depth during manual CPR. Chest compressions were deeper with mechanical CPR. The mean hands-off time was shorter with manual CPR.
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143
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Calvo-Buey JA, Calvo-Marcos D, Marcos-Camina RM. [Randomised study of the relationship between the use of CPRmeter® device and the quality of chest compressions in a simulated cardiopulmonary resuscitation]. ENFERMERIA INTENSIVA 2015; 27:13-21. [PMID: 26573267 DOI: 10.1016/j.enfi.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether the use of CPRmeter(®) during the resuscitation manoeuvres, is related to a higher quality of external cardiac massage, as recommended by the International Liaison Committee on Resuscitation (ILCOR). To compare the quality obtained without the use or this, and whether there are differences related to anthropometric, demographic, professional and/or occupational factors. METHOD Experimental, open trial performed with life support simulators in a stratified random sample of 88 health workers randomly distributed between groups A (without indications of the device) and B (with them). The homogeneity of their confounding variables was compared, as well as the compressions depth and compressions rate, the proportion of completed release, and distribution of the quality massage variable (according to criteria ILCOR) between the groups. The qualitative variables were analysed with the chi-square test, and quantitative variables with the Student t-test or Mann-Whitney U-test and the association between the variable quality massage variable, and use of the device with the odds ratio. RESULTS Group A: mean depth 42.1mm (standard deviation 10.1), mean rate 121.3/min (21.6), percentage of complete release 71.2% (36.9). Group B: 51.2mm (5.9) 111.9/min (6.4), 92.9% (10.1) respectively. Odds ratio for quality massage regarding the use of the device was 5.170 (95% CI; 2.060-12.977). CONCLUSIONS The use of CPRmeter(®) device in simulated resuscitations is related to a higher quality of cardiac massage, improving the approach to the ILCOR recommendations, regardless of the characteristics of the participants. They were 83.8% more likely to achieve a quality massage using the device than without it.
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Affiliation(s)
- J A Calvo-Buey
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - D Calvo-Marcos
- Intensiv Station, Helios Amper-Klinikum Dachau, Dachau, Alemania
| | - R M Marcos-Camina
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, España
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144
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Truszewski Z, Szarpak L, Kurowski A, Evrin T, Zasko P, Bogdanski L, Czyzewski L. Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. Am J Emerg Med 2015; 34:381-5. [PMID: 26612703 DOI: 10.1016/j.ajem.2015.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. METHODS This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. RESULTS Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)). CONCLUSIONS During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.
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Affiliation(s)
- Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Kurowski
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
| | - Piotr Zasko
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Lukasz Bogdanski
- Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Lukasz Czyzewski
- Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland
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145
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González-Otero DM, de Gauna SR, Ruiz J, Chicote B, Rivero R, Russell JK. Accurate feedback of chest compression depth and rate on a manikin in a moving train. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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146
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de Vries W, Maas M. Fact or fiction: AED connected to conscious patients with VT. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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147
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Burkhardt JN, Glick JE, Terndrup TE. Effect of prior cardiopulmonary resuscitation knowledge on compression performance by hospital providers. West J Emerg Med 2015; 15:404-8. [PMID: 25035744 PMCID: PMC4100844 DOI: 10.5811/westjem.2014.1.19636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/19/2013] [Accepted: 01/27/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. METHODS This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. RESULTS Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (μ=117 vs. 94, p<0.001). Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (μ=86% vs. 72%, p<0.01). No significant differences were found in depth or recoil performance based on knowledge of guidelines. CONCLUSION Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.
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Affiliation(s)
| | | | - Thomas E Terndrup
- Ohio State University, Department of Emergency Medicine, Columbus, Ohio
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148
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Xu J, Li C, Zheng L, Han F, Li Y, Walline J, Fu Y, Yao D, Zhang X, Zhang H, Zhu H, Guo S, Wang Z, Yu X. Pulse Oximetry: A Non-Invasive, Novel Marker for the Quality of Chest Compressions in Porcine Models of Cardiac Arrest. PLoS One 2015; 10:e0139707. [PMID: 26485651 PMCID: PMC4613139 DOI: 10.1371/journal.pone.0139707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Pulse oximetry, which noninvasively detects the blood flow of peripheral tissue, has achieved widespread clinical use. We have noticed that the better the quality of cardiopulmonary resuscitation (CPR), the better the appearance of pulse oximetry plethysmographic waveform (POP). We investigated whether the area under the curve (AUC) and/or the amplitude (Amp) of POP could be used to monitor the quality of CPR. Design Prospective, randomized controlled study. Setting Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China. Subjects Healthy 3-month-old male domestic swine. Interventions 34 local pigs were enrolled in this study. After 4 minutes of untreated ventricular fibrillation, animals were randomly assigned into two resuscitation groups: a “low quality” group (with a compression depth of 3cm) and a “high quality” group (with a depth of 5cm). All treatments between the two groups were identical except for the depth of chest compressions. Hemodynamic parameters [coronary perfusion pressure (CPP), partial pressure of end-tidal carbon dioxide (PETCO2)] as well as AUC and Amp of POP were all collected and analyzed. Measurements and Findings There were statistical differences between the “high quality” group and the “low quality” group in AUC, Amp, CPP and PETCO2 during CPR (P<0.05). AUC, Amp and CPP were positively correlated with PETCO2, respectively (P<0.01). There was no statistical difference between the heart rate calculated according to the POP (FCPR) and the frequency of mechanical CPR at the 3rd minute of CPR. The FCPR was lower than the frequency of mechanical CPR at the 6th and the 9th minute of CPR. Conclusions Both the AUC and Amp of POP correlated well with CPP and PETCO2 in animal models. The frequency of POP closely matched the CPR heart rate. AUC and Amp of POP might be potential noninvasive quality monitoring markers for CPR.
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Affiliation(s)
- Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Chen Li
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | | | - Fei Han
- Institute of Life Monitoring, Mindray Corporation, Shenzhen, China
| | - Yan Li
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Joseph Walline
- Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Dongqi Yao
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Xiaocui Zhang
- Institute of Life Monitoring, Mindray Corporation, Shenzhen, China
| | - Hui Zhang
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Shubin Guo
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Zhong Wang
- Emergency Department, Beijing Tsinghua Chang Gung Hospital, Beijing, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
- * E-mail:
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149
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Smart JR, Kranz K, Carmona F, Lindner TW, Newton A. Does real-time objective feedback and competition improve performance and quality in manikin CPR training--a prospective observational study from several European EMS. Scand J Trauma Resusc Emerg Med 2015; 23:79. [PMID: 26471882 PMCID: PMC4608309 DOI: 10.1186/s13049-015-0160-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train. METHODS Ten European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p < 0.05. RESULTS Overall mean Improvement of CPR performance from Stage 1 to Stage 2 was significant. The improvement was greater for the infant assessment. The participants thought the real-time feedback very useful (mean score of 8.5) and very easy to use (mean score of 8.2). Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0. CONCLUSIONS The results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.
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Affiliation(s)
- J R Smart
- Research Consultant for South East Coast Ambulance NHS Trust (SECAmb), Banstead, UK.
| | - K Kranz
- Swiss Institute of Emergency Medicine (SIRMED), Nottwil, Switzerland
| | - F Carmona
- Sistema Emergencias Mediques (SEM), Barcelona, Spain
| | - T W Lindner
- Norwegian Air Ambulance Foundation, Drøbak, Norway
- SAFER (Stavanger Acute medicine Foundation for Education and Research) and Stavanger University Hospital, Stavanger, Norway
| | - A Newton
- South East Coast Ambulance NHS Trust (SECAmb), Banstead, UK
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150
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Cheong SA, Oh JH, Kim CW, Kim SE, Lee DH. Effects of alternating hands during in-hospital one-handed chest compression: A randomised cross-over manikin trial. Emerg Med Australas 2015; 27:567-572. [DOI: 10.1111/1742-6723.12492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sin Ae Cheong
- Department of Emergency Medicine; College of Medicine; Chung-Ang University; Seoul Republic of Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine; College of Medicine; Chung-Ang University; Seoul Republic of Korea
| | - Chan Woong Kim
- Department of Emergency Medicine; College of Medicine; Chung-Ang University; Seoul Republic of Korea
| | - Sung Eun Kim
- Department of Emergency Medicine; College of Medicine; Chung-Ang University; Seoul Republic of Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine; College of Medicine; Chung-Ang University; Seoul Republic of Korea
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