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Kahsay DT, Salanterä S, Tommila M, Liukas T, Rosio R, Diji AKA, Peltonen LM. User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation. Comput Inform Nurs 2024; 42:583-592. [PMID: 38470258 DOI: 10.1097/cin.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.
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Affiliation(s)
- Desale Tewelde Kahsay
- Author Affiliations: Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Turku (Mr Kahsay); Department of Nursing Science, Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland (Drs Salanterä and Peltonen), and Department of Perioperative Services, Intensive Care Medicine and Pain Management (Dr Tommila), Turku University Hospital and University of Turku; and Department of Nursing Science, Faculty of Medicine, University of Turku (Ms Liukas), Finland; Department of Nursing, Kwame Nkrumah, University of Science and Technology, Ghana (Dr Diji)
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Huang LW, Chan YW, Tsan YT, Zhang QX, Chan WC, Yang HH. Implementation of a Smart Teaching and Assessment System for High-Quality Cardiopulmonary Resuscitation. Diagnostics (Basel) 2024; 14:995. [PMID: 38786293 PMCID: PMC11120156 DOI: 10.3390/diagnostics14100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this study is to develop a smart training and assessment system called SmartCPR, for teaching and training cardiopulmonary resuscitation (CPR), based on human posture estimation techniques. In this system, trainees can automatically recognize and evaluate whether chest compressions during CPR meet the standard of high-quality CPR by simply using a device such as a smart phone. Through the system, trainees are able to obtain real-time feedback on the quality of compressions so that they can adjust the cycle, depth, frequency, and posture of compressions to meet the standard of high-quality CPR. In addition, the SmartCPR system is convenient for CPR trainers. Trainers can instantly and accurately assess whether the trainee's compressions meet the standard of high-quality CPR, which reduces the risk of manual assessment errors and also reduces the trainer's teaching pressures. Therefore, the SmartCPR system developed in this study can be an important tool for CPR teaching and training for physicians, which can provide training and guidance for high-quality CPR maneuvers and enable trainees to become more proficient in CPR and self-training.
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Affiliation(s)
- Li-Wen Huang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
| | - Yu-Wei Chan
- Department of Computer Science and Information Management, Providence University, Taichung 40301, Taiwan;
| | - Yu-Tse Tsan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Qi-Xiang Zhang
- Department of Computer Science and Information Engineering, Providence University, Taichung 40301, Taiwan
| | - Wei-Chang Chan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-W.H.); (Y.-T.T.); (W.-C.C.)
| | - Han-Hsuan Yang
- Everlink Occupational Medicine Clinic, Taichung 40760, Taiwan;
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Kahsay DT, Peltonen LM, Rosio R, Tommila M, Salanterä S. The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:11-20. [PMID: 37154435 DOI: 10.1093/eurjcn/zvad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
AIMS Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training. METHOD AND RESULT Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included. The intervention evaluated was the quality of chest compressions with standalone AVF devices vs. without AVF devices. Databases, such as PubMed, Cochrane Central, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and PsycINFO, were searched from January 2010 to January 2022. The risk of bias was assessed using the Cochrane risk of bias tool. A meta-analysis alongside a narrative synthesis was used for examining the effect of standalone AVF devices.Sixteen studies were selected for this systematic review. A meta-analysis revealed an increased compression depth of 2.22 mm [95% CI (Confidence Interval), 0.88-3.55, P = 0.001] when participants performed CPR using the feedback devices. Besides, AVF devices enabled laypersons to deliver compression rates closer to the recommended range of 100-120 per min. No improvement was noted in chest recoil and hand positioning when participants used standalone AVF devices. CONCLUSION The quality of the included studies was variable, and different standalone AVF devices were used. Standalone AVF devices were instrumental in guiding laypersons to deliver deeper compressions without compromising the quality of compression rates. However, the devices did not improve the quality of chest recoil and placement of the hands. REGISTRATION PROSPERO: CRD42020205754.
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Affiliation(s)
- Desale Tewelde Kahsay
- Department of Anaesthesiology and Intensive Care, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | | | - Riitta Rosio
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Miretta Tommila
- Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
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Leo WZ, Chua D, Tan HC, Ho VK. Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study. Sci Rep 2023; 13:19852. [PMID: 37964016 PMCID: PMC10645752 DOI: 10.1038/s41598-023-46862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.
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Affiliation(s)
- Wen Zhe Leo
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Damien Chua
- Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Hui Cheng Tan
- Department of Clinical Governance, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
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Sood N, Sangari A, Goyal A, Sun C, Horinek M, Hauger JA, Perry L. Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis. World J Cardiol 2023; 15:531-541. [PMID: 37900903 PMCID: PMC10600786 DOI: 10.4330/wjc.v15.i10.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA. METHODS We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05. RESULTS Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047]. CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.
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Affiliation(s)
- Nitish Sood
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
| | - Anish Sangari
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Arnav Goyal
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Christina Sun
- Dental College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Madison Horinek
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Joseph Andy Hauger
- Department of Chemistry and Physics, Augusta University, Augusta, GA 30912, United States
| | - Lane Perry
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
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Szöllősi V, Horváth B, Németh D, Bánfai-Csonka H, Betlehem J, Bánfai B. A randomized controlled simulation trial comparing video-assisted with telephone-assisted and unassisted cardiopulmonary resuscitation performed by non-healthcare university students. Sci Rep 2023; 13:14925. [PMID: 37696968 PMCID: PMC10495456 DOI: 10.1038/s41598-023-42131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
Our randomized controlled simulation study aimed to compare the CPR quality, time-related factors, attitude and self-assessment of non-healthcare university students (aged 18-25) compared video-assisted (V-CPR, n = 50) with telephone-assisted (T-CPR, n = 49) and unassisted (U-CPR, n = 48) CPR in a simulation setting. Regarding to chest compression depth, no difference was found between the three groups (p = 0.065): 41.8 mm, SD = 9.9 in the V-CPR; 35.9 mm, SD = 11.6 in the T-CPR; and 39.4 mm, SD = 15.6 in the U-CPR group. The mean chest compression rate was the best in the V-CPR group (100.9 min-1, SD = 17.1) which was superior to the T-CPR (82.4 min-1, SD = 35.4; p = 0.005), and the U-CPR (84.2 min-1, SD = 30.6; p = 0.013) groups. The overall proportion of correct hand position was the highest in the V-CPR group (48, 96%), compared to the T-CPR (28, 57.1%; p = 0.001), and the U-CPR (34, 70.8%; p = 0.001) groups. V-CPR led to a delay in the time to the first chest compression compared with the U-CPR group (77.5 s, SD = 19.2 vs. 31.3 s, SD = 13.3, p < 0.001). Although V-CPR technology holds the potential to improve overall CPR quality, the importance of appropriate chest compression depth should be emphasized in training for laypeople and dispatchers, as well. Our study was registered at ClinicalTrials.gov (NCT05639868, 06/12/2022).
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Affiliation(s)
- Vivien Szöllősi
- Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary
- National Ambulance Service, Szombathely, Hungary
| | - Balázs Horváth
- National Ambulance Service, Szombathely, Hungary
- Doctoral School of Health Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary
| | | | - Henrietta Bánfai-Csonka
- Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary
- Doctoral School of Health Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary
- Department of Emergency Medicine, Clinical Centre, University of Pécs, Ifjúság Street 13., 7624, Pécs, Hungary
| | - József Betlehem
- Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary
| | - Bálint Bánfai
- Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs Faculty of Health Sciences, Vörösmarty Street 4, 7621, Pécs, Hungary.
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Marks S, Shaffer L, Zehnder D, Aeh D, Prall DM. Under pressure: What individual characteristics lead to performance of high-quality chest compressions during CPR practice sessions? Resusc Plus 2023; 14:100380. [PMID: 37035444 PMCID: PMC10074238 DOI: 10.1016/j.resplu.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Aim Despite well-established protocols for cardiopulmonary resuscitation training, performance during real-life cardiac arrests can be suboptimal. Understanding personal characteristics which could influence performance of high-quality chest compressions could provide insight into the practice-performance gap. This study examined chest compression performance, while employing feedback and introducing code team sounds as an anxiety-inducing factor in registered nurses using a cardiopulmonary resuscitation training manikin. Methods Participants included 120 registered nurses with basic life support certification randomized to one of the following groups: no feedback and no code team sounds, feedback without code team sounds, or feedback with code team sounds. Chest compression sessions occurred at baseline, 30-days and 60-days. Demographic variables and anxiety level were also collected. The primary outcome was chest compression performance, defined as average percent of time with correct rate and percent with correct depth as captured by the defibrillator. Statistical analysis included linear mixed effects analysis. Results The effect of feedback on chest compression performance depended on the value of other parameters. The benefit of feedback on the primary outcome depended on: age, with feedback less beneficial among older participants (p = 0.0413); and time, with feedback more beneficial with repetition (p = 0.011). These interactions also affected the outcome percent of time with correct compression depth. Increased anxiety was associated with decreased percent correct compression depth (p < 0.001). Conclusion Feedback emerged as important in determining chest compression performance. Chest compression quality was limited by the performer's age and anxiety level. Future research should focus on identifying factors related to individual characteristics which may influence chest compression performance.
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Gillam L, Crawshaw B, Booker M, Allsop S. Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system. BMC MEDICAL EDUCATION 2023; 23:303. [PMID: 37131183 PMCID: PMC10152634 DOI: 10.1186/s12909-023-04225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Bristol Medical School has adopted a near peer-led teaching approach to deliver Basic Life Support training to first year undergraduate medical students. Challenges arose when trying to identify early in the course which candidates were struggling with their learning, in sessions delivered to large cohorts. We developed and piloted a novel, online performance scoring system to better track and highlight candidate progress. METHODS During this pilot, a 10-point scale was used to evaluate candidate performance at six time-points during their training. The scores were collated and entered on an anonymised secure spreadsheet, which was conditionally formatted to provide a visual representation of the score. A One-Way ANOVA was performed on the scores and trends analysed during each course to review candidate trajectory. Descriptive statistics were assessed. Values are presented as mean scores with standard deviation (x̄±SD). RESULTS A significant linear trend was demonstrated (P < 0.001) for the progression of candidates over the course. The average session score increased from 4.61 ± 1.78 at the start to 7.92 ± 1.22 at the end of the final session. A threshold of less than 1SD below the mean was used to identify struggling candidates at any of the six given timepoints. This threshold enabled efficient highlighting of struggling candidates in real time. CONCLUSIONS Although the system will be subject to further validation, our pilot has shown the use of a simple 10-point scoring system in combination with a visual representation of performance helps to identify struggling candidates earlier across large cohorts of students undertaking skills training such as Basic Life Support. This early identification enables effective and efficient remedial support.
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Affiliation(s)
| | | | | | - Sarah Allsop
- University of Bristol Medical School, Bristol, UK
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Tobase L, Peres HHC, Polastri TF, Cardoso SH, Souza DR, Almeida DG, Timerman S. The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation. Arq Bras Cardiol 2022; 120:e20220240. [PMID: 36629602 PMCID: PMC9833294 DOI: 10.36660/abc.20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. OBJECTIVES To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. METHODS Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. RESULTS 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. CONCLUSIONS The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.
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Affiliation(s)
- Lucia Tobase
- Centro Universitário São CamiloSão PauloSPBrasilCentro Universitário São Camilo, São Paulo, SP – Brasil
| | - Heloisa Helena Ciqueto Peres
- Escola de EnfermagemUniversidade de São PauloDepartamento de Orientação ProfissionalSão PauloSPBrasilEscola de Enfermagem da Universidade de São Paulo – Departamento de Orientação Profissional, São Paulo, SP – Brasil
| | - Thatiane Facholi Polastri
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP – Brasil
| | - Sandra Helena Cardoso
- Escola de EnfermagemUniversidade de São PauloDepartamento de Orientação ProfissionalSão PauloSPBrasilEscola de Enfermagem da Universidade de São Paulo – Departamento de Orientação Profissional, São Paulo, SP – Brasil
| | - Dhieizom Rodrigo Souza
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP – Brasil
| | | | - Sergio Timerman
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilUniversidade de São Paulo Instituto do Coração, São Paulo, SP – Brasil
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Advanced and Invasive Cardiopulmonary Resuscitation (CPR) Techniques as an Adjunct to Advanced Cardiac Life Support. J Clin Med 2022; 11:jcm11247315. [PMID: 36555932 PMCID: PMC9781548 DOI: 10.3390/jcm11247315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. METHODS A selective literature search in the core databases with a focus on randomized controlled trials and guidelines. RESULTS Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. CONCLUSIONS It is crucial to identify those patients who may benefit from an advanced or invasive procedure and make the decision to implement the intervention in a timely manner. As with all infrequently performed procedures, sound education and regular training are paramount.
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Gugelmin-Almeida D, Tobase L, Maconochie I, Polastri T, Rodrigues Gesteira EC, Williams J. What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature. Resusc Plus 2022; 12:100319. [PMCID: PMC9630773 DOI: 10.1016/j.resplu.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer’s confidence. Methods This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer.
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Key Words
- paediatric cardiopulmonary resuscitation
- training strategies
- retraining intervals
- scoping review
- healthcare professionals
- apls, advanced paediatric life support
- atls, advanced trauma life support
- bls, basic life support
- cpr, cardiopulmonary resuscitation
- em, emergency medical
- ems, emergency medical services
- epals, european paediatric advanced life support
- ilcor, international liaison committee on resuscitation
- pcpr, paediatric cardiopulmonary resuscitation
- pals, paediatric advanced life support
- phpls, pre-hospital paediatric life support
- pils, paediatric intermediate life support
- rct, randomised controlled trial
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England,Corresponding author.
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Ian Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Thatiane Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England
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Interactive Teaching Aid Kit for Cardiopulmonary Resuscitation. Processes (Basel) 2022. [DOI: 10.3390/pr10081515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on a person experiencing cardiac arrest to manually preserve brain function until spontaneous breathing and blood circulation can be restored. If performed timely and properly, it can improve the survival rate of a person experiencing cardiac arrest. The promotion of CPR has always been an important task for countries around the world. Countries around the world often hold relevant study camps and seminars to improve the public’s awareness of CPR. On the basis of this rationale, this paper proposes an interactive teaching aid kit for CPR that uses a CPR manikin and tutoring software to facilitate CPR learning among trainees. The CPR manikin is equipped with sensors that determine whether the CPR steps are performed correctly. Data from the sensors are sent to the tutoring software through wireless transmission. The software provides video demonstrations and textual instructions concerning the standard CPR procedure. In this software, the interactive interface displays real-time information about the trainee’s CPR process, such as information on the CPR step being performed and the number of chest compression and breaths given. Thus, this teaching aid kit allows trainees to learn CPR without an instructor. This system may enable CPR to become a readily learnable skill for the general population.
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Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study. Pediatr Res 2022; 91:1762-1768. [PMID: 34290385 PMCID: PMC9270220 DOI: 10.1038/s41390-021-01653-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. METHODS This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. RESULTS Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant's chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants' subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. CONCLUSIONS The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. IMPACT Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.
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A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer. Eur J Pediatr 2022; 181:4101-4109. [PMID: 36114832 PMCID: PMC9483516 DOI: 10.1007/s00431-022-04625-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
Abstract
Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months. Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.
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Timerman S, Polatri TF. Retention of Cardiopulmonary Resuscitation Skills in Medical Students: What Can Be Done to Improve Them? Arq Bras Cardiol 2021; 117:1036-1037. [PMID: 34817014 PMCID: PMC8682110 DOI: 10.36660/abc.20210856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sergio Timerman
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Thatiane Facholi Polatri
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Ching CK, Leong BSH, Nair P, Chan KC, Seow E, Lee F, Heng K, Sewa DW, Lim TW, Chong DTT, Yeo KK, Fong WK, Anantharaman V, Lim SH. Singapore Advanced Cardiac Life Support Guidelines 2021. Singapore Med J 2021; 62:390-403. [PMID: 35001112 PMCID: PMC8804484 DOI: 10.11622/smedj.2021109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.
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Affiliation(s)
- Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Praseetha Nair
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kim Chai Chan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Eillyne Seow
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Francis Lee
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kenneth Heng
- Emergency Medicine Department, Tan Tock Seng Hospital, Singapore
| | - Duu Wen Sewa
- Department of Respiratory Medicine, Singapore General Hospital, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Hospital, Singapore
| | | | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Kim Fong
- Department of Anaesthesia, Tan Tock Seng Hospital, Singapore
| | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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